Provider Demographics
NPI:1780936906
Name:DOUS, GEORGE V
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:V
Last Name:DOUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W BASTANCHURY RD
Mailing Address - Street 2:STE 240
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3430
Mailing Address - Country:US
Mailing Address - Phone:714-853-1218
Mailing Address - Fax:714-853-1224
Practice Address - Street 1:999 S FAIRMONT AVE STE 130
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240
Practice Address - Country:US
Practice Address - Phone:209-336-2001
Practice Address - Fax:209-366-2022
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA132794207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program