MEDICARE: DR. ALFRED ROBERTS DOOLEY ED.D.

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	103T00000X	Psychologist	02372	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00TN 32	OTHER	TX	BC/BS

General Provider Information

NPI Number	:	1770679193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFRED ROBERTS DOOLEY ED.D.

Provider Business Mailing Address
First Line	:	1900 CEDAR RIDGE DR.
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78741-3904
Country	:	US
Telephone Number	:	512-445-2315
Fax Number	:	512-445-2315

Provider Business Practice Location Address
First Line	:	2107 N. MAYS
Second Line	:	STE. 101
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-2155
Country	:	US
Telephone Number	:	512-828-0800
Fax Number	:	512-445-2315

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/09/2007

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