Healthcare Provider Details

I. General information

NPI: 1982947461
Provider Name (Legal Business Name): MICHAEL THOMAS DOERING FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15510 W BELL RD
SURPRISE AZ
85374-3436
US

IV. Provider business mailing address

2620 ELM HILL PIKE
NASHVILLE TN
37214-3108
US

V. Phone/Fax

Practice location:
  • Phone: 480-717-4903
  • Fax: 480-717-4904
Mailing address:
  • Phone: 615-425-4200
  • Fax: 615-425-4268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4861
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: