Provider Demographics
NPI:1548900434
Name:DOUGAN, THOMAS EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWARD
Last Name:DOUGAN
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:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2299 RIVER OAKS BLVD
Practice Address - Street 2:
Practice Address - City:PLUMAS LAKE
Practice Address - State:CA
Practice Address - Zip Code:95961-9194
Practice Address - Country:US
Practice Address - Phone:530-772-5801
Practice Address - Fax:530-772-5807
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA204948207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty