MEDICARE: MR. JOEL DANIEL DOUGHTEN 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	207Q00000X	Family Medicine Physician	A45021	CA
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	A45021	CA

General Provider Information

NPI Number	:	1740348226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOEL DANIEL DOUGHTEN MD

Provider Business Mailing Address
First Line	:	4435 BROCKTON AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92501-4004
Country	:	US
Telephone Number	:	951-682-9900
Fax Number	:	951-682-1272

Provider Business Practice Location Address
First Line	:	4435 BROCKTON AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92501-4004
Country	:	US
Telephone Number	:	951-682-9900
Fax Number	:	951-682-1272

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	11/05/2009

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