Healthcare Provider Details

I. General information

NPI: 1154783579
Provider Name (Legal Business Name): TODD DOYLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 03/10/2023
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N PROVIDENCE DR
NEWBERG OR
97132-7485
US

IV. Provider business mailing address

1776 OAK ST
LAKE OSWEGO OR
97034-4624
US

V. Phone/Fax

Practice location:
  • Phone: 503-537-1555
  • Fax:
Mailing address:
  • Phone: 337-794-6280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number307394
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: