Provider Demographics
NPI:1831183045
Name:DOHERTY, PAUL WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WILLIAM
Last Name:DOHERTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 N. EL CIELO
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262
Mailing Address - Country:US
Mailing Address - Phone:760-323-8657
Mailing Address - Fax:760-318-9083
Practice Address - Street 1:275 N. EL CIELO
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262
Practice Address - Country:US
Practice Address - Phone:760-323-8657
Practice Address - Fax:760-318-9083
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30599207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA30599OtherPIN
CA00A305990Medicaid
CAA67534Medicare UPIN
CA00A305990Medicaid