Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MDR9541 | MO |
Y | 208600000X | Surgeon | MDR9541 | MO |
NPI | 1003800244 |
---|---|
Provider Name | Carl Raymond Doerhoff |
First Address | Jefferson City, MO 65101-5195 |
Second Address | Jefferson City, MO 65101-5195 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2005 |
Last Update Date | 04/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201704814 | (05) | MO |
A13682 | (02) |