Provider Demographics
NPI:1255396941
Name:DORAN, OWEN MARTIN (PA-C)
Entity type:Individual
Prefix:MR
First Name:OWEN
Middle Name:MARTIN
Last Name:DORAN
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:333 EAST CAMPUS MALL
Mailing Address - Street 2:#5123
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1381
Mailing Address - Country:US
Mailing Address - Phone:608-262-2948
Mailing Address - Fax:608-262-0674
Practice Address - Street 1:333 EAST CAMPUS MALL
Practice Address - Street 2:#5123
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1381
Practice Address - Country:US
Practice Address - Phone:608-262-2948
Practice Address - Fax:608-262-0674
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2023-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI737363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1255396941Medicaid