1336399682 NPI number — DR. MICHAEL GREGORY DOORLY MD, MS

Table of content: DR. MICHAEL GREGORY DOORLY MD, MS (NPI 1336399682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336399682 NPI number — DR. MICHAEL GREGORY DOORLY MD, MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOORLY
Provider First Name:
MICHAEL
Provider Middle Name:
GREGORY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336399682
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
364 SE 8TH AVE
Provider Second Line Business Mailing Address:
SUITE 301A
Provider Business Mailing Address City Name:
HILLSBORO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97123-4253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-681-4310
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
364 SE 8TH AVE
Provider Second Line Business Practice Location Address:
SUITE 301A
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97123-4253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-681-4310
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208C00000X , with the licence number:  A116072 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0A1160720 . This is a "BLUE SHIELD PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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