Provider Demographics
NPI:1043481377
Name:FREDERICK B DOERFLER JR
Entity Type:Organization
Organization Name:FREDERICK B DOERFLER JR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:DOERFLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:724-545-1288
Mailing Address - Street 1:260 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-2422
Mailing Address - Country:US
Mailing Address - Phone:724-545-1288
Mailing Address - Fax:724-545-7615
Practice Address - Street 1:260 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-2422
Practice Address - Country:US
Practice Address - Phone:724-545-1288
Practice Address - Fax:724-545-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207R00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty