Provider Demographics
NPI:1710988191
Name:DOYLE, AL R (MD)
Entity Type:Individual
Prefix:
First Name:AL
Middle Name:R
Last Name:DOYLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3754
Mailing Address - Country:US
Mailing Address - Phone:309-757-0300
Mailing Address - Fax:309-757-0400
Practice Address - Street 1:111 19TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-3754
Practice Address - Country:US
Practice Address - Phone:309-757-0300
Practice Address - Fax:309-757-0400
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0169094Medicaid
IA40678Medicare ID - Type Unspecified
IA0169094Medicaid