Provider Demographics
NPI:1982675021
Name:DOGGETT, STEPHEN W (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:W
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 2901
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-0375
Mailing Address - Country:US
Mailing Address - Phone:714-573-9500
Mailing Address - Fax:714-573-9505
Practice Address - Street 1:14642 NEWPORT AVE
Practice Address - Street 2:#470
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6057
Practice Address - Country:US
Practice Address - Phone:714-573-9500
Practice Address - Fax:714-573-9505
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG498562085R0001X
MS186432085R0001X
AZAZ474602085R0001X
WAMD 000317502085R0001X
AZ474602085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G498560Medicaid
CA00G498560OtherBLUE SHIELD
CA920001601OtherMEDICARE RAILROAD
CA00G498561Medicaid
CACG086XMedicare PIN
CACG086YMedicare PIN
CACG086ZMedicare PIN
CA00G498561Medicaid
CACG086WMedicare PIN
WAG8926651Medicare PIN
CACG086UMedicare PIN
CAWG49856AMedicare ID - Type UnspecifiedMEDICARE RENDERING
CAG49856BMedicare ID - Type Unspecified
CACA116100Medicare PIN
CA00G498560OtherBLUE SHIELD
CAHW10580Medicare ID - Type UnspecifiedMEDICARE SOUTHERN
CA00G498560Medicaid
CACG086TMedicare PIN
CA00G498560Medicare ID - Type UnspecifiedMEDICARE NORTHERN
CACG086VMedicare PIN