Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | L9947483 | IL |
NPI | 1003258211 |
---|---|
Provider Name | Dr. Mark Robert Doerrfeld |
First Address | Rock Island, IL 61201-5304 |
Second Address | Rock Island, IL 61201-5304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2013 |
Last Update Date | 29/07/2013 |