MEDICARE: TIMOTHY R. DOOLEY, M.D., PROFESSIONAL CORPORATION

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	208D00000X	General Practice Physician	G69284	CA

General Provider Information

NPI Number	:	1679900419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMOTHY R. DOOLEY, M.D., PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	2525 CAMINO DEL RIO S STE 130
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3718
Country	:	US
Telephone Number	:	619-297-8641
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 CAMINO DEL RIO S STE 130
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3718
Country	:	US
Telephone Number	:	619-297-8641
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	TIMOTHY RUPERT DOOLEY
Credential	:	MD
Telephone Number	:	619-297-8641

Provider Enumeration Date	:	10/10/2013
Last Update Date	:	07/08/2022

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