MEDICARE: ELISHEBA DOUGAN MD

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	106S00000X	Behavior Technician	0673

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	:	1619751146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISHEBA DOUGAN MD

Provider Business Mailing Address
First Line	:	14765 W MOUNTAIN VIEW BLVD # 107
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-2704
Country	:	US
Telephone Number	:	602-649-0245
Fax Number	:

Provider Business Practice Location Address
First Line	:	14765 W MOUNTAIN VIEW BLVD # 107
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-2704
Country	:	US
Telephone Number	:	602-649-0245
Fax Number	:

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

Provider Enumeration Date	:	08/24/2023
Last Update Date	:	03/26/2026

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Directions to “ ELISHEBA DOUGAN MD” Practice Location

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