Healthcare Provider Details

I. General information

NPI: 1538180229
Provider Name (Legal Business Name): BAKERSFIELD INTERNAL MEDICINE ASSOCIATES A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 SAN DIMAS ST
BAKERSFIELD CA
93301-1458
US

IV. Provider business mailing address

3900 SAN DIMAS ST
BAKERSFIELD CA
93301-1458
US

V. Phone/Fax

Practice location:
  • Phone: 661-323-6102
  • Fax: 661-323-6113
Mailing address:
  • Phone: 661-323-6102
  • Fax: 661-323-6113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG47681
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License NumberG47681
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberG47681
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG47681
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG47681
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberG47681
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG47681
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberG47681
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberG47681
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberG47681
License Number StateCA
# 11
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberG47681
License Number StateCA
# 12
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberG47681
License Number StateCA
# 13
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG47681
License Number StateCA
# 14
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberG47681
License Number StateCA
# 15
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberG47681
License Number StateCA

VIII. Authorized Official

Name: DAVID CHARLES DOUGHERTY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 661-323-6102