Provider Demographics
NPI:1902179237
Name:DOYLE, CORRIE ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:ANNE
Last Name:DOYLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 SE SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9777
Mailing Address - Country:US
Mailing Address - Phone:503-571-5780
Mailing Address - Fax:503-571-8987
Practice Address - Street 1:9900 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9777
Practice Address - Country:US
Practice Address - Phone:503-571-5780
Practice Address - Fax:503-571-8987
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA156811363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORPENDINGMedicaid
ORPA156811OtherOREGON STATE LICENSE
ORPENDINGMedicare PIN