Healthcare Provider Details

I. General information

NPI: 1821057936
Provider Name (Legal Business Name): BRIAN DOGGETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 ARMORY RD
DELPHI IN
46923-1910
US

IV. Provider business mailing address

PO BOX 5545
LAFAYETTE IN
47903-5545
US

V. Phone/Fax

Practice location:
  • Phone: 765-448-8000
  • Fax: 765-564-6580
Mailing address:
  • Phone: 765-448-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01030617A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierDO25507008
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer
# 2
Identifier9396981
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerPHCS PID NUMBER
# 3
Identifier100117210
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer
# 4
Identifier000000189506
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerANTHEM PROVIDER NUMBER
# 5
Identifier11484429
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerCAQH NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: