MEDICARE: GREGORY A DOAK 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	207R00000X	Internal Medicine Physician	R5C46	MO

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	:	1588650741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY A DOAK MD

Provider Business Mailing Address
First Line	:	601 E 14TH ST
Second Line	:	PO BOX 1706
City	:	SEDALIA
State	:	MO
Zip	:	65301-5972
Country	:	US
Telephone Number	:	660-827-9407
Fax Number	:	660-827-3742

Provider Business Practice Location Address
First Line	:	3700 W 10TH ST
Second Line	:	SUITE 301
City	:	SEDALIA
State	:	MO
Zip	:	65301-2540
Country	:	US
Telephone Number	:	660-827-2730
Fax Number	:	660-827-2731

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

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	12/23/2014

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Directions to “ GREGORY A DOAK MD” Practice Location

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