Provider Demographics
NPI:1477196715
Name:THE DOCTORS MEDICAL CLINIC, P.A.
Entity Type:Organization
Organization Name:THE DOCTORS MEDICAL CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAOKOU
Authorized Official - Middle Name:MARCUS
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:651-771-2513
Mailing Address - Street 1:1504 WHITEBEAR AVE
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106
Mailing Address - Country:US
Mailing Address - Phone:615-771-2513
Mailing Address - Fax:651-771-2514
Practice Address - Street 1:1504 WHITEBEAR AVE
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106
Practice Address - Country:US
Practice Address - Phone:615-771-2513
Practice Address - Fax:651-771-2514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty