MEDICARE: DR. SEAN CAMERON DOYLE D.O.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5101014857	MI
2	207Q00000X	Family Medicine Physician	6167776-1204	UT

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1026429	OTHER	UT	DESERET HEALTHCARE TRUST
3	107047817101	OTHER	UT	SELECT HEALTH
4	30595	OTHER	UT	ALTIUS
5	87029387384062B003	OTHER	UT	TRICARE
6	870293873SCD	OTHER	UT	EMI HEALTH
7	97137	OTHER	UT	PEHP

NPI Number	:	1235138751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN CAMERON DOYLE D.O.

Provider Business Mailing Address
First Line	:	830 N 2000 W
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-4047
Country	:	US
Telephone Number	:	801-756-3511
Fax Number	:	801-443-1164

Provider Business Practice Location Address
First Line	:	830 N 2000 W
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-4047
Country	:	US
Telephone Number	:	801-756-3511
Fax Number	:	801-443-1164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	04/29/2013

872 N 2000 W , SUITE A
PLEASANT GROVE, UT
84062-4047

Practice Phone: 801-492-8900
Practice Fax: