MEDICARE: DR. EDWARD DORAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	036062499	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285622340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD DORAN MD

Provider Business Mailing Address
First Line	:	530 PARK AVE E
Second Line	:	SUITE 7
City	:	PRINCETON
State	:	IL
Zip	:	61356-3901
Country	:	US
Telephone Number	:	815-875-8666
Fax Number	:	815-872-0487

Provider Business Practice Location Address
First Line	:	530 PARK AVE E
Second Line	:	SUITE 7
City	:	PRINCETON
State	:	IL
Zip	:	61356-3901
Country	:	US
Telephone Number	:	815-875-8666
Fax Number	:	815-872-0487

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	04/13/2019

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