Provider Demographics
NPI:1528198934
Name:DOEZIE, ALLEN M (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:M
Last Name:DOEZIE
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 3266
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92690-1266
Mailing Address - Country:US
Mailing Address - Phone:949-481-9850
Mailing Address - Fax:949-481-9875
Practice Address - Street 1:600 CORPORATE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2106
Practice Address - Country:US
Practice Address - Phone:949-481-9850
Practice Address - Fax:949-481-9875
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69209208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18245Medicare ID - Type Unspecified
CAI04700Medicare UPIN