Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | R5C47 | MO |
Y | 207PP0204X | Pediatric Emergency Physician | 036.135847 | IL |
NPI | 1528005154 |
---|---|
Provider Name | Dr. Faye E Doerhoff |
First Address | Springfield, IL 62769-1000 |
Second Address | Springfield, IL 62769-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 04/01/2022 |