MEDICARE: DR. THOMAS EDWARD DOUGAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A204948	CA

General Provider Information

NPI Number	:	1548900434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS EDWARD DOUGAN MD

Provider Business Mailing Address
First Line	:	PO BOX 255228
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95865-5228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2299 RIVER OAKS BLVD
Second Line	:
City	:	PLUMAS LAKE
State	:	CA
Zip	:	95961-9194
Country	:	US
Telephone Number	:	530-772-5801
Fax Number	:	530-772-5807

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2022
Last Update Date	:	11/11/2025

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