MEDICARE: DONNA SUE DOLLE, M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	J6407	TX

General Provider Information

NPI Number	:	1336361476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONNA SUE DOLLE, M.D., P.A.

Provider Business Mailing Address
First Line	:	2060 SPACE PARK DR STE 304
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3675
Country	:	US
Telephone Number	:	281-333-8840
Fax Number	:	281-335-7598

Provider Business Practice Location Address
First Line	:	2060 SPACE PARK DR STE 304
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3675
Country	:	US
Telephone Number	:	281-333-8840
Fax Number	:	281-335-7598

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. DONNA SUE DOLLE
Credential	:	MD
Telephone Number	:	281-333-8840

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	08/22/2020

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