Basic Information
| Provider Information | |||||||||
| NPI: | 1902003601 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOOLEY | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | TAYLOR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 707 N EMPORIA ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672143707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3168583460 | ||||||||
| FaxNumber: | 3168583458 | ||||||||
| Practice Location | |||||||||
| Address1: | 707 N EMPORIA ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672143707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3168583460 | ||||||||
| FaxNumber: | 3168583458 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2007 | ||||||||
| LastUpdateDate: | 06/24/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 04-37204 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110173288 | 01 | MEDICARE | OTHER | 200535200A | 01 | OK | OK MEDICAID | OTHER |