Basic Information
| Provider Information | |||||||||
| NPI: | 1114912961 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOYLE | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3107 CLEARWATER DR | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863057167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284452522 | ||||||||
| FaxNumber: | 9284451910 | ||||||||
| Practice Location | |||||||||
| Address1: | 3107 CLEARWATER DR | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863057167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284452522 | ||||||||
| FaxNumber: | 9284451910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2005 | ||||||||
| LastUpdateDate: | 08/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 24495 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QA0505X | 24495 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207QG0300X | 24495 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | 207QH0002X | 24495 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
No ID Information.