Provider Demographics
NPI:1144371055
Name:DOTY, THOMAS A (PA)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:A
Last Name:DOTY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81625-2019
Mailing Address - Country:US
Mailing Address - Phone:970-326-3236
Mailing Address - Fax:
Practice Address - Street 1:785 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-2019
Practice Address - Country:US
Practice Address - Phone:970-326-3236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1231363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC800678Medicare PIN
Q33461Medicare UPIN
CO542310YMCJMedicare PIN