Healthcare Provider Details

I. General information

NPI: 1003859661
Provider Name (Legal Business Name): ALEXANDER D DOAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N BASCOM AVE #103
SAN JOSE CA
95128-1811
US

IV. Provider business mailing address

105 N BASCOM AVE 103
SAN JOSE CA
95128-1811
US

V. Phone/Fax

Practice location:
  • Phone: 408-998-2890
  • Fax: 408-998-2897
Mailing address:
  • Phone: 408-998-2890
  • Fax: 408-998-2897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA62476
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: