MEDICARE: DR. GARY NEIL DOLIN MD

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	207W00000X	Ophthalmology Physician	ME 34043	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00363318	OTHER	FL	RRMC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619971330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY NEIL DOLIN MD

Provider Business Mailing Address
First Line	:	426 MANATEE AVE W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34205-8845
Country	:	US
Telephone Number	:	941-708-9000
Fax Number	:	941-746-7365

Provider Business Practice Location Address
First Line	:	426 MANATEE AVE W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34205-8845
Country	:	US
Telephone Number	:	941-708-9000
Fax Number	:	941-746-7365

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	12/16/2009

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