Provider Demographics
NPI:1477606911
Name:DOERING, BRENT ALAN
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ALAN
Last Name:DOERING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S SAMPSON ST
Mailing Address - Street 2:
Mailing Address - City:TREMONT
Mailing Address - State:IL
Mailing Address - Zip Code:61568-8620
Mailing Address - Country:US
Mailing Address - Phone:309-241-6345
Mailing Address - Fax:309-676-1928
Practice Address - Street 1:820 S SAMPSON ST
Practice Address - Street 2:
Practice Address - City:TREMONT
Practice Address - State:IL
Practice Address - Zip Code:61568-8620
Practice Address - Country:US
Practice Address - Phone:309-241-6345
Practice Address - Fax:309-676-1928
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist