Provider Demographics
NPI:1780976324
Name:DOSKOCIL, BRANDON JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:JAMES
Last Name:DOSKOCIL
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2608 MARSH WREN WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-8185
Mailing Address - Country:US
Mailing Address - Phone:928-853-5029
Mailing Address - Fax:
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:SUITE 3100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-703-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1233442085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ72623OtherPERMIT NUMBER
CA123344OtherCALIFORNIA MEDICAL LICENSE