Provider Demographics
NPI:1114566585
Name:DOYLE, BRIAN PATRICK (PA-C, MSPAS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:PATRICK
Last Name:DOYLE
Suffix:
Gender:M
Credentials:PA-C, MSPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 BUCKLES CT N STE 100
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6924
Mailing Address - Country:US
Mailing Address - Phone:614-231-2729
Mailing Address - Fax:614-231-6088
Practice Address - Street 1:680 BUCKLES CT N STE 100
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-6924
Practice Address - Country:US
Practice Address - Phone:614-231-2729
Practice Address - Fax:614-231-6088
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006303RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0394521Medicaid