Provider Demographics
NPI:1902003601
Name:DOOLEY, PHILIP TAYLOR (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:TAYLOR
Last Name:DOOLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:707 N EMPORIA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3707
Mailing Address - Country:US
Mailing Address - Phone:316-858-3460
Mailing Address - Fax:316-858-3458
Practice Address - Street 1:707 N EMPORIA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3707
Practice Address - Country:US
Practice Address - Phone:316-858-3460
Practice Address - Fax:316-858-3458
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-37204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110173288OtherMEDICARE
OK200535200AOtherOK MEDICAID