Active NPI
Sally Elizabeth Doyle, MD
- Obstetrics Physician
- Vancouver, WA
National Provider Identifier
1790886026
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics Physician
- License
- MD00045384
- Practice address
- 2211 NE 139TH St
Vancouver, WA 98686-2742 - Phone
- (360) 487-4295
- Fax
- (360) 487-5049
- NPI assigned
- Sep 26, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics Physician | 207VX0000X | MD00045384 | WA | Primary |
| Obstetrics Physician | 207VX0000X | MD26234 | OR |
Addresses
Primary practice location
2211 NE 139TH St
Vancouver, WA 98686-2742
Mailing address
2211 NE 139TH St
Vancouver, WA 98686-2742
Phone (360) 487-4295
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 005801 | Medicaid | OR | |
| 8438681 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00045384 | WA | MD | Obstetrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Legacy Clinics LLC | Obstetrics | Current | Accepting new patients |
Locations
1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134
1130 NW 22nd Ave
Ste 500
Portland, OR 97210
Phone (503) 229-7339
2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790886026",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2211 NE 139TH ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986862742",
"telephone_number": "360-487-4295",
"fax_number": "360-487-5049"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2211 NE 139TH ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986862742",
"telephone_number": "360-487-4295",
"fax_number": "360-487-5049"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOYLE",
"first_name": "SALLY",
"middle_name": "ELIZABETH",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207VX0000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Obstetrics",
"state": "WA",
"license": "MD00045384",
"primary": true
},
{
"code": "207VX0000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Obstetrics",
"state": "OR",
"license": "MD26234",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "005801",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8438681",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.