Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | H3242 | TX |
NPI | 1003978529 |
---|---|
Provider Name | Dr. Eric Larson Doane |
First Address | Fort Gordon, GA 30905-5650 |
Second Address | Fort Gordon, GA 30905-5650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 03/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD 000 | (02) | GA |