Provider Demographics
NPI:1437248648
Name:BRIAN K DOERR DPM PA
Entity Type:Organization
Organization Name:BRIAN K DOERR DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DOERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-931-3668
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
Mailing Address - Country:US
Mailing Address - Phone:239-931-3668
Mailing Address - Fax:239-333-3669
Practice Address - Street 1:14391 METROPOLIS AVENUE
Practice Address - Street 2:SUITE 103
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912
Practice Address - Country:US
Practice Address - Phone:239-931-3668
Practice Address - Fax:239-333-3669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3044213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5813790001Medicare NSC