MEDICARE: ALEXIS DOUGHERTY, INC

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	207N00000X	Dermatology Physician	A126933	CA

General Provider Information

NPI Number	:	1568832657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEXIS DOUGHERTY, INC

Provider Business Mailing Address
First Line	:	601 E ARRELLAGA ST STE 101
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93103-2275
Country	:	US
Telephone Number	:	832-341-9832
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 E ARRELLAGA ST STE 101
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93103-2275
Country	:	US
Telephone Number	:	805-687-5538
Fax Number	:	805-687-5530

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. ALEXIS DOUGHERTY
Credential	:	M.D.
Telephone Number	:	832-341-9832

Provider Enumeration Date	:	10/01/2015
Last Update Date	:	08/04/2020

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Directions to “ALEXIS DOUGHERTY, INC ” Practice Location

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