Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1760 | TX |
Y | 222Z00000X | Podiatrist | 1760 | TX |
NPI | 1013921568 |
---|---|
Provider Name | Dr. Robert Jeffrey Doyle |
First Address | Garland, TX 75044-5691 |
Second Address | Garland, TX 75044-5691 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 17/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1760 | STATE LICENSE (01) | TX |
V09707 | (02) | TX |