Provider Demographics
NPI:1831784354
Name:DOYLE, BEDAR STEPHANE (BSMT/USAR)
Entity type:Individual
Prefix:
First Name:BEDAR
Middle Name:STEPHANE
Last Name:DOYLE
Suffix:
Gender:F
Credentials:BSMT/USAR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 551
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-0010
Mailing Address - Country:US
Mailing Address - Phone:214-729-7978
Mailing Address - Fax:281-596-7574
Practice Address - Street 1:304 N WASHINGTON AVE STE B
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-9126
Practice Address - Country:US
Practice Address - Phone:214-729-7978
Practice Address - Fax:281-596-7574
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2147203291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory