Healthcare Provider Details

I. General information

NPI: 1982755161
Provider Name (Legal Business Name): LORI ANN DOYLE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORI ANN LONG PA

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 03/07/2023
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PARADISE RD
MODESTO CA
95351-3163
US

IV. Provider business mailing address

401 PARADISE RD
MODESTO CA
95351-3163
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-4000
  • Fax:
Mailing address:
  • Phone: 209-558-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA13554
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: