Basic Information
| Provider Information | |||||||||
| NPI: | 1598037814 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOERING | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2580 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658012580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178294620 | ||||||||
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| Practice Location | |||||||||
| Address1: | 550 S HUDSON AVE | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656052362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4176785176 | ||||||||
| FaxNumber: | 4176780675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2012 | ||||||||
| LastUpdateDate: | 10/24/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 2012003298 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 431560263 | 01 | MO | TRICARE | OTHER | P01062306 | 01 | MO | RR MCR | OTHER |