Provider Demographics
NPI:1740578855
Name:DORO, REBECCA KRISTEEN (DO)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:KRISTEEN
Last Name:DORO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:KRISTEEN
Other - Last Name:BICKFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:122 E COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5794
Mailing Address - Country:US
Mailing Address - Phone:920-996-3264
Mailing Address - Fax:920-830-5910
Practice Address - Street 1:520 W 3RD ST
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:WI
Practice Address - Zip Code:54136-1300
Practice Address - Country:US
Practice Address - Phone:920-788-7680
Practice Address - Fax:920-788-7688
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60777-21207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine