| Mary Beth Doyle, MD | |
|
310 W Losey St, Scott Afb, IL 62225-5250 | |
| (618) 256-7018 | |
| (618) 256-7594 |
| Full Name | Mary Beth Doyle |
|---|---|
| Gender | Female |
| Speciality | Pediatrics |
| Location | 310 W Losey St, Scott Afb, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841352655 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 0116018403 (Virginia) | Secondary |
| 208000000X | Pediatrics | 0101242353 (Virginia) | Secondary |
| 208000000X | Pediatrics | 036.126007 (Illinois) | Primary |
| Entity Name | Clark Regional Physician Practices Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1780356253 PECOS PAC ID: 9739337569 Enrollment ID: O20120919000575 |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Beth Doyle, MD 5 Matthew Allen Ct, Troy, IL 62294-4009 Ph: (757) 763-9933 | Mary Beth Doyle, MD 310 W Losey St, Scott Afb, IL 62225-5250 Ph: (618) 256-7018 |
Chauncey Denise Tarrant, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 310 W Losey St, Scott Afb, IL 62225 Phone: 618-256-7018 | |
Jeremy David Moll, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 310 W Losey St, Scott Afb, IL 62225 Phone: 618-256-7827 | |
Dr. Zachary Aaron Ross, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 310 W Losey St Bldg 1530, Scott Afb, IL 62225 Phone: 618-256-9355 | |
Kristine Eva Andrews, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 375 Medical Group, 310 W. Losey Street, Scott Afb, IL 62225 Phone: 618-256-7018 Fax: 618-256-7594 |