Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | PD009409 | MI |
NPI | 1053483826 |
---|---|
Provider Name | Phillip Thomas Doyle |
First Address | Kalamazoo, MI 49008 |
Second Address | Kalamazoo, MI 49008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P54813 | (02) |