Healthcare Provider Details

I. General information

NPI: 1346206042
Provider Name (Legal Business Name): THOMAS B DOYLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9515 HOLY CROSS LANE
BREESE IL
62230
US

IV. Provider business mailing address

1715 DEER TRACKS TRAIL STE 130
ST LOUIS MO
63131
US

V. Phone/Fax

Practice location:
  • Phone: 618-526-4511
  • Fax: 618-526-0556
Mailing address:
  • Phone: 314-821-5600
  • Fax: 314-821-2180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036063855
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: