Provider Demographics
NPI:1194816769
Name:DOYLE, COLIN STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:STEPHEN
Last Name:DOYLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3779 SWALLOWS NEST CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-1738
Mailing Address - Country:US
Mailing Address - Phone:208-503-0629
Mailing Address - Fax:
Practice Address - Street 1:3779 SWALLOWS NEST CT
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-1738
Practice Address - Country:US
Practice Address - Phone:208-503-0629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-3499207Y00000X, 208600000X
WAMD00014948207Y00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000010003514OtherREGENCE BLUESHIELD OF ID
WA1103407Medicaid
ID002456000Medicaid
S3085OtherBLUE CROSS OF IDAHO
S3085OtherBLUE CROSS OF IDAHO
ID002456000Medicaid
B63306Medicare UPIN