Healthcare Provider Details

I. General information

NPI: 1881742831
Provider Name (Legal Business Name): THOMAS C. DOERNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 06/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E CESAR E CHAVEZ AVE STE 403
LOS ANGELES CA
90033-2425
US

IV. Provider business mailing address

1701 CEASAR E. CHAVEZ AVE. SUITE403
LOS ANGELES CA
90033
US

V. Phone/Fax

Practice location:
  • Phone: 323-224-2040
  • Fax:
Mailing address:
  • Phone: 323-224-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberG30583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: