Provider Demographics
NPI:1720471444
Name:DOE MEDICAL INC
Entity Type:Organization
Organization Name:DOE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-412-8910
Mailing Address - Street 1:30 E RIVER PARK PL W
Mailing Address - Street 2:STE 320
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1539
Mailing Address - Country:US
Mailing Address - Phone:559-412-8910
Mailing Address - Fax:559-492-1111
Practice Address - Street 1:30 E RIVER PARK PL W
Practice Address - Street 2:STE 320
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1539
Practice Address - Country:US
Practice Address - Phone:559-412-8910
Practice Address - Fax:559-492-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105109207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty