Edward Doran, MD
Individual provider Active NPI Gastroenterology Physician · Princeton, IL
NPI 1285622340 · NPPES record last updated Apr 13, 2019
Key facts
- NPI
- 1285622340
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gastroenterology Physician 207RG0100X
- License
- 036062499 (IL)
- Practice address
- 530 Park Ave E
Suite 7
Princeton, IL 61356-3901 - Phone
- (815) 875-8666
- Fax
- (815) 872-0487
- NPI assigned
- Oct 12, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060316000078 | IL | Practitioner - Internal Medicine |
3678580735 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Interoperability endpoints
- edwarddoran@agc.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 036062499 | IL | Yes |
Addresses
Primary practice location
530 Park Ave E
Suite 7
Princeton, IL 61356-3901
Mailing address
530 Park Ave E
Suite 7
Princeton, IL 61356-3901
Phone (815) 875-8666
Other practice location 1
1310 Maple Dr Ste 7
Peru, IL 61354-1361
Phone (815) 223-1666
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036062499 | Medicaid | IL |
Other providers in Princeton, IL
- Carol A Debruhl
- Dennis a Farrell Enterprises, LTD.
- Jennifer Jo Derubeis
- Geetha Dodda
- Donald R Marion OD
- Rachel Dose
- Robbie Duckworth
- Alan Dumontier
- Jeffrey D Dzik
- Grace Eager
All providers in Princeton, IL · Gastroenterology Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 13, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.