Provider Demographics
NPI:1467412023
Name:DOVGAN, DANIEL J (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:DOVGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1445
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1445
Mailing Address - Country:US
Mailing Address - Phone:866-388-2916
Mailing Address - Fax:855-388-4124
Practice Address - Street 1:907 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5015
Practice Address - Country:US
Practice Address - Phone:865-977-5567
Practice Address - Fax:865-980-4962
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN274732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64923386Medicaid
TN4023058OtherBC/BS OF TN
TN300125493OtherRR MCARE
TN3097904Medicaid
TNG01422Medicare UPIN
TN300125493OtherRR MCARE
TN300125493Medicare PIN