MEDICARE: DERRIAL DOYLE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1117388	TX

General Provider Information

NPI Number	:	1578253621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DERRIAL DOYLE

Provider Business Mailing Address
First Line	:	5414 YORKWOOD ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77016-2644
Country	:	US
Telephone Number	:	832-818-2592
Fax Number	:

Provider Business Practice Location Address
First Line	:	138B FAIRMONT PKWY
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-2740
Country	:	US
Telephone Number	:	281-707-7353
Fax Number	:

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

Provider Enumeration Date	:	05/11/2023
Last Update Date	:	09/01/2023

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