Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 16268 | NE |
N | 208600000X | Surgeon | 16268 | NE |
Y | 208200000X | Surgeon | R8D67 | MO |
Y | 208600000X | Surgeon | R8D67 | MO |
N | 208D00000X | General Practice Physician | 04-19991 | KS |
NPI | 1013987064 |
---|---|
Provider Name | Doak Peter Doolittle |
First Address | Gordon, NE 69343-1132 |
Second Address | Gordon, NE 69343-1132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 05/12/2019 |