Provider Demographics
NPI:1427281666
Name:STEPHEN WILLIAM DOGGETT, M.D. PA
Entity type:Organization
Organization Name:STEPHEN WILLIAM DOGGETT, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DOGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-573-9500
Mailing Address - Street 1:PO BOX 2901
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-0375
Mailing Address - Country:US
Mailing Address - Phone:714-573-9500
Mailing Address - Fax:714-573-9505
Practice Address - Street 1:14642 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6057
Practice Address - Country:US
Practice Address - Phone:714-573-9500
Practice Address - Fax:714-573-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG498562085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8926652Medicare PIN
CACA116099Medicare PIN
CACH251EMedicare PIN
CACH251AMedicare PIN
AZZ165229Medicare PIN
CACH251FMedicare PIN
CACH251CMedicare PIN
CACH251GMedicare PIN
CACH151BMedicare PIN
CACH251DMedicare PIN