Provider Demographics
NPI:1326005703
Name:DOOLEY, JOHN B (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:DOOLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5515 UTICA RIDGE RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3928
Mailing Address - Country:US
Mailing Address - Phone:563-344-1050
Mailing Address - Fax:563-424-4579
Practice Address - Street 1:5515 UTICA RIDGE RD
Practice Address - Street 2:SUITE 600
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3928
Practice Address - Country:US
Practice Address - Phone:563-344-1050
Practice Address - Fax:563-424-4579
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA25065174400000X, 207L00000X, 208VP0000X, 173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No174400000XOther Service ProvidersSpecialist
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0048314Medicaid
A03719Medicare UPIN
IA0048314Medicaid