Provider Demographics
NPI:1477560738
Name:DOERR, MARK J (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:DOERR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:500 STERLING DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1573
Mailing Address - Country:US
Mailing Address - Phone:716-677-2273
Mailing Address - Fax:716-677-2256
Practice Address - Street 1:500 STERLING DR
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1573
Practice Address - Country:US
Practice Address - Phone:716-677-2273
Practice Address - Fax:716-677-2256
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN48602208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00427425OtherRAILROAD MEDICARE
MN986918000Medicaid
MN986918000Medicaid
I57850Medicare UPIN