Provider Demographics
NPI:1790537082
Name:DOYLE, JOHN WALTER III (CRPA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WALTER
Last Name:DOYLE
Suffix:III
Gender:M
Credentials:CRPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CAYUDUTTA STREET
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078
Mailing Address - Country:US
Mailing Address - Phone:518-725-5646
Mailing Address - Fax:518-725-5645
Practice Address - Street 1:8-10 FIRST AVE
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078
Practice Address - Country:US
Practice Address - Phone:518-725-5646
Practice Address - Fax:518-725-5645
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist