Provider Demographics
NPI:1003071234
Name:DOAK, JEREMY PAUL (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:PAUL
Last Name:DOAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 MAIN ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6755
Mailing Address - Country:US
Mailing Address - Phone:716-906-5908
Mailing Address - Fax:
Practice Address - Street 1:4949 HARLEM RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-2500
Practice Address - Country:US
Practice Address - Phone:716-204-3251
Practice Address - Fax:716-204-3269
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPENDING207X00000X
RI14215207X00000X
NY274278207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery