Provider Demographics
NPI:1437153236
Name:DOERR, BRIAN K (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:K
Last Name:DOERR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14391 METROPOLIS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4421
Mailing Address - Country:US
Mailing Address - Phone:239-931-3668
Mailing Address - Fax:239-333-3669
Practice Address - Street 1:14391 METROPOLIS AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4421
Practice Address - Country:US
Practice Address - Phone:239-931-3668
Practice Address - Fax:239-333-3669
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0003044213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340443900Medicaid
FL340443900Medicaid
FLV00649Medicare UPIN