MEDICARE: RENEE ELIZABETH DOLL 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	Q9335	TX
2	207L00000X	Anesthesiology Physician	MD448573	PA
3	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME146609	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871823849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE ELIZABETH DOLL MD

Provider Business Mailing Address
First Line	:	705 WELLS RD STE 300
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-2982
Country	:	US
Telephone Number	:	904-282-6331
Fax Number	:	904-619-1080

Provider Business Practice Location Address
First Line	:	463386 STATE ROAD 200 UNIT A
Second Line	:
City	:	YULEE
State	:	FL
Zip	:	32097-3240
Country	:	US
Telephone Number	:	904-468-3080
Fax Number	:	904-468-3193

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

Provider Enumeration Date	:	01/13/2010
Last Update Date	:	08/22/2022

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Directions to “ RENEE ELIZABETH DOLL MD” Practice Location

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