Healthcare Provider Details

I. General information

NPI: 1306848965
Provider Name (Legal Business Name): BRIAN S DOORECK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 LAKE BOONE TRL
RALEIGH NC
27607-7505
US

IV. Provider business mailing address

2245 N UNIVERSITY DR
PEMBROKE PINES FL
33024-3611
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-5050
  • Fax: 919-784-1487
Mailing address:
  • Phone: 954-963-0888
  • Fax: 954-985-9818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2024-02434
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number99812
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME85567
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberDR.0074596
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number5171076
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: