Healthcare Provider Details

I. General information

NPI: 1326005703
Provider Name (Legal Business Name): JOHN B. DOOLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 UTICA RIDGE RD SUITE 600
DAVENPORT IA
52807-3928
US

IV. Provider business mailing address

5515 UTICA RIDGE RD SUITE 600
DAVENPORT IA
52807-3928
US

V. Phone/Fax

Practice location:
  • Phone: 563-344-1050
  • Fax: 563-424-4579
Mailing address:
  • Phone: 563-344-1050
  • Fax: 563-424-4579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number25065
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25065
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number25065
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number25065
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: