Provider Demographics
NPI:1821057936
Name:DOGGETT, BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:DOGGETT
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 5545
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-5545
Mailing Address - Country:US
Mailing Address - Phone:765-448-8000
Mailing Address - Fax:
Practice Address - Street 1:651 ARMORY RD
Practice Address - Street 2:
Practice Address - City:DELPHI
Practice Address - State:IN
Practice Address - Zip Code:46923-1910
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-564-6580
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030617A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDO25507008Medicaid
IN9396981OtherPHCS PID NUMBER
IN100117210Medicaid
IN000000189506OtherANTHEM PROVIDER NUMBER
IN11484429OtherCAQH NUMBER
INDO25507008Medicaid
IND94598Medicare UPIN
IN142090EMedicare PIN
IN815510XXMedicare PIN
IN080121481Medicare PIN
IN100117210Medicaid
IN815520DDDMedicare PIN