Provider Demographics
NPI:1639349525
Name:ALLEN M DOEZIE, M.D. PC
Entity type:Organization
Organization Name:ALLEN M DOEZIE, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOEZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-527-1082
Mailing Address - Street 1:600 CORPORATE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2106
Mailing Address - Country:US
Mailing Address - Phone:714-527-1082
Mailing Address - Fax:
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:714-527-1082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W18245Medicare PIN
I04700Medicare UPIN