Provider Demographics
NPI:1194808717
Name:DOERR, JOHN J (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:DOERR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 684
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-0684
Mailing Address - Country:US
Mailing Address - Phone:973-777-5022
Mailing Address - Fax:973-594-4769
Practice Address - Street 1:914 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2708
Practice Address - Country:US
Practice Address - Phone:973-777-5022
Practice Address - Fax:973-594-4769
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0489662471B0102X, 2471C3402X, 2471M2300X, 2471S1302X
NJ25MA048966002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone Densitometry
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1433709Medicaid
NJ429083OtherAETNA
NJ24F95OtherEMPIRE BC/BS SITE #200
NJF10779OtherHEALTH NET
NJ60377891OtherMULTIPLAN
NJ24F952OtherWELL CHOICE
NJA3392920OtherOXFORD
NJF10779OtherHEALTH NET
NJ533762Medicare ID - Type Unspecified