Provider Demographics
NPI:1942206933
Name:DOGGWILER, KURT O (MD, PHD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:O
Last Name:DOGGWILER
Suffix:
Gender:M
Credentials:MD, PHD
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 21609
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89721-1609
Mailing Address - Country:US
Mailing Address - Phone:775-884-2455
Mailing Address - Fax:775-884-0345
Practice Address - Street 1:1310 24TH AVE S # 114
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2637
Practice Address - Country:US
Practice Address - Phone:615-873-7765
Practice Address - Fax:615-873-8321
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV90002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1104927300Medicaid
CA1942206933Medicaid
NVP000606388OtherRAILROAD MEDICARE
NVV102849Medicare PIN
CA1942206933Medicaid