Provider Demographics
NPI:1760466460
Name:DOERFER, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:DOERFER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:740 REENA AVE
Mailing Address - Street 2:STE A
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-3145
Mailing Address - Country:US
Mailing Address - Phone:920-563-0888
Mailing Address - Fax:920-568-3516
Practice Address - Street 1:740 REENA AVE
Practice Address - Street 2:STE A
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-3145
Practice Address - Country:US
Practice Address - Phone:920-563-0888
Practice Address - Fax:920-568-3516
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2016-01-21
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Provider Licenses
StateLicense IDTaxonomies
WI49794-020207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1760466460Medicaid
WI1760466460Medicaid
WIK400178483Medicare PIN