Provider Demographics
NPI:1285782847
Name:DOSS, R PHILIP (MD, FACS)
Entity type:Individual
Prefix:DR
First Name:R PHILIP
Middle Name:
Last Name:DOSS
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:DR
Other - First Name:RAID
Other - Middle Name:PHILIP
Other - Last Name:DOSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, FACS
Mailing Address - Street 1:1828 E CESAR E CHAVEZ AVE STE 6500
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2585
Mailing Address - Country:US
Mailing Address - Phone:323-263-6774
Mailing Address - Fax:323-263-1277
Practice Address - Street 1:1828 E CESAR E CHAVEZ AVE STE 6500
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2585
Practice Address - Country:US
Practice Address - Phone:323-263-6774
Practice Address - Fax:323-263-1277
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE84377Medicare UPIN