Healthcare Provider Details

I. General information

NPI: 1841369196
Provider Name (Legal Business Name): JEFFREY RYAN DOERINGER LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 02/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CARRIAGE HILL DR
ATHENS OH
45701-3213
US

IV. Provider business mailing address

121 CARRIAGE HILL DR
ATHENS OH
45701-3213
US

V. Phone/Fax

Practice location:
  • Phone: 570-362-3572
  • Fax:
Mailing address:
  • Phone: 570-362-3572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberAT002773
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: