| Doctor Name: | RANDLE EARL DOTY |
| NPI Number: | 1124237839 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 209003697 |
| Business Practice Address: | 200 S Broadway # 40 Goreville, IL - 629392447 |
| Business Phone Number: | 6189952396 |
| Business Fax Number: | 6189952947 |
| Mailing Address: | Po Box 717, CARRIER MILLS |
| State: | IL |
| Postal Code: | 629170717 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/21/2007 |
| NPI Last Update Date: | 09/14/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 209003697 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |