Healthcare Provider Details

I. General information

NPI: 1902179237
Provider Name (Legal Business Name): CORRIE ANNE DOYLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 SE SUNNYSIDE RD
CLACKAMAS OR
97015-9777
US

IV. Provider business mailing address

9900 SE SUNNYSIDE RD
CLACKAMAS OR
97015-9777
US

V. Phone/Fax

Practice location:
  • Phone: 503-571-5780
  • Fax: 503-571-8987
Mailing address:
  • Phone: 503-571-5780
  • Fax: 503-571-8987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA156811
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPENDING
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
IdentifierPA156811
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerOREGON STATE LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: