MEDICARE: MR. OWEN MARTIN DORAN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	737	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255396941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. OWEN MARTIN DORAN PA-C

Provider Business Mailing Address
First Line	:	333 EAST CAMPUS MALL
Second Line	:	#5123
City	:	MADISON
State	:	WI
Zip	:	53715-1381
Country	:	US
Telephone Number	:	608-262-2948
Fax Number	:	608-262-0674

Provider Business Practice Location Address
First Line	:	333 EAST CAMPUS MALL
Second Line	:	#5123
City	:	MADISON
State	:	WI
Zip	:	53715-1381
Country	:	US
Telephone Number	:	608-262-2948
Fax Number	:	608-262-0674

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	02/10/2023

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