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General NPI Number Information
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NPI Number | 1720471444
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Entity Type | Organization
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Legal Business Name | DOE MEDICAL INC
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 09/25/2015
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Provider Practice Location Address
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Address Line | 30 E RIVER PARK PL W STE 320
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City | FRESNO
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State | CA
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Zip | 93720-1539
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Country | US
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Telephone | 559-412-8910
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Fax | 559-492-1111
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Provider Business Mailing Address
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Address Line | 30 E RIVER PARK PL W STE 320
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City | FRESNO
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State | CA
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Zip | 93720-1539
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Country | US
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Telephone | 559-412-8910
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Fax | 559-492-1111
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. MARIAN DOE
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Credential | M.D.
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Telephone | 559-412-8910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A105109
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License Number State | CA
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