Healthcare Provider Details

I. General information

NPI: 1710431879
Provider Name (Legal Business Name): ERIC JAMES DOYLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2016
Last Update Date: 08/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5024 COSTA UASCA DR NW
ALBUQUERQUE NM
87120-5790
US

IV. Provider business mailing address

5024 COSTA UASCA DR NW
ALBUQUERQUE NM
87120-5790
US

V. Phone/Fax

Practice location:
  • Phone: 505-250-2439
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: