Provider Demographics
NPI:1033671219
Name:DOTY, MITRA SALIGHEDAR (DO)
Entity type:Individual
Prefix:
First Name:MITRA
Middle Name:SALIGHEDAR
Last Name:DOTY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 AIR PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-3000
Mailing Address - Country:US
Mailing Address - Phone:903-408-1100
Mailing Address - Fax:469-902-9551
Practice Address - Street 1:4264 STATE HIGHWAY 66 STE A
Practice Address - Street 2:
Practice Address - City:CADDO MILLS
Practice Address - State:TX
Practice Address - Zip Code:75135-6270
Practice Address - Country:US
Practice Address - Phone:903-408-5000
Practice Address - Fax:469-902-9551
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.015666207Q00000X
TXV0382207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine