Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 904555 | MS |
N | 207QA0505X | Family Doctor - Adult Medicine | 904555 | TN |
Y | 207RG0300X | Geriatric Medicine | 904555 | MS |
N | 207RG0300X | Geriatric Medicine | 904555 | TN |
NPI | 1013596089 |
---|---|
Provider Name | Shavonne Bridgette Doyle |
First Address | Oxford, MS 38655-5375 |
Second Address | Oxford, MS 38655-5375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2021 |
Last Update Date | 03/02/2022 |