Provider Demographics
NPI:1497580435
Name:DOERR, MARK EDWIN
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:EDWIN
Last Name:DOERR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 MILLIKIN RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9222
Mailing Address - Country:US
Mailing Address - Phone:513-470-1393
Mailing Address - Fax:
Practice Address - Street 1:7010 MILLIKIN RD
Practice Address - Street 2:
Practice Address - City:LIBERTY TWP
Practice Address - State:OH
Practice Address - Zip Code:45044-9222
Practice Address - Country:US
Practice Address - Phone:513-470-1393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker