=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215169313
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOANECARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2009
-----------------------------------------------------
Last Update Date | 08/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 S GLENOAKS BLVD SUITE 303
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91502-1474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-674-1110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 W GLENOAKS BLVD SUITE 743
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91202-2896
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-674-1110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MATTHEW A DOANE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 888-674-1110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | A104400
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------