Provider Demographics
NPI:1730523531
Name:DOTY, JESSICA N (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:N
Last Name:DOTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3580 RC LUTTRELL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-9736
Mailing Address - Country:US
Mailing Address - Phone:405-928-6100
Mailing Address - Fax:405-928-8222
Practice Address - Street 1:3580 RC LUTTRELL DR STE 102
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-9736
Practice Address - Country:US
Practice Address - Phone:405-928-6100
Practice Address - Fax:405-928-8222
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29910207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000145956Medicaid