Healthcare Provider Details

I. General information

NPI: 1013987064
Provider Name (Legal Business Name): DOAK PETER DOOLITTLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 N ASH ST
GORDON NE
69343-1132
US

IV. Provider business mailing address

807 N ASH ST
GORDON NE
69343-1132
US

V. Phone/Fax

Practice location:
  • Phone: 308-282-1442
  • Fax: 308-282-1428
Mailing address:
  • Phone: 308-282-1442
  • Fax: 308-282-1428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number16268
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number04-19991
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR8D67
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: