Provider Demographics
NPI:1508925348
Name:DOYLE, BRETT COLBY (DPH)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:COLBY
Last Name:DOYLE
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24963 STATE ROAD 22
Mailing Address - Street 2:
Mailing Address - City:CADDO
Mailing Address - State:OK
Mailing Address - Zip Code:74729-2218
Mailing Address - Country:US
Mailing Address - Phone:580-367-2395
Mailing Address - Fax:580-439-8846
Practice Address - Street 1:211 W MAIN AVE
Practice Address - Street 2:
Practice Address - City:COMANCHE
Practice Address - State:OK
Practice Address - Zip Code:73529-1445
Practice Address - Country:US
Practice Address - Phone:580-439-8846
Practice Address - Fax:580-439-8846
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3711505OtherNABP
OK3711505OtherNABP