Provider Demographics
NPI:1699734897
Name:DOERING, RICHARD BAILEY (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:BAILEY
Last Name:DOERING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1218
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-0218
Mailing Address - Country:US
Mailing Address - Phone:949-631-6002
Mailing Address - Fax:949-631-6982
Practice Address - Street 1:351 HOSPITAL RD
Practice Address - Street 2:401
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3509
Practice Address - Country:US
Practice Address - Phone:949-631-6002
Practice Address - Fax:949-631-6982
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA288992086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABP527ZMedicare PIN
CAE22845Medicare UPIN
CAA28899Medicare PIN