Healthcare Provider Details

I. General information

NPI: 1700825171
Provider Name (Legal Business Name): DAN DOUER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

633 3RD AVE BOX 3
NEW YORK NY
10017-6706
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-2471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberA36194
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number261841
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: