Healthcare Provider Details

I. General information

NPI: 1396803698
Provider Name (Legal Business Name): DOYLE PARK FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 DOYLE PARK DR
SANTA ROSA CA
95405-4570
US

IV. Provider business mailing address

510 DOYLE PARK DR
SANTA ROSA CA
95405-4570
US

V. Phone/Fax

Practice location:
  • Phone: 707-526-1800
  • Fax: 707-522-1737
Mailing address:
  • Phone: 707-526-1800
  • Fax: 707-522-1737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY MCLEOD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 707-526-1800