Healthcare Provider Details

I. General information

NPI: 1215980032
Provider Name (Legal Business Name): MARILYN MAE DOYLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 E 12TH ST STE 104
AUSTIN TX
78701-1954
US

IV. Provider business mailing address

301 UNIVERSITY BLVD PROVIDER ENROLLMENT, RT. 1022
GALVESTON TX
77555-5302
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-2222
  • Fax: 409-772-0885
Mailing address:
  • Phone: 409-747-0890
  • Fax: 409-772-0885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberF4024
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberF4024
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: