Provider Demographics
NPI:1962412122
Name:DOGGETT, LEWIS (M D)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:
Last Name:DOGGETT
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 LEIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5782
Mailing Address - Country:US
Mailing Address - Phone:256-237-1618
Mailing Address - Fax:256-237-2661
Practice Address - Street 1:1001 LEIGHTON AVENUE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5782
Practice Address - Country:US
Practice Address - Phone:256-237-1618
Practice Address - Fax:256-237-2661
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00015180208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1210952OtherUNITED HEALTH CARE
AL009931864Medicaid
AL202833406OtherALL COMMERCIAL CLAIMS
AL051001420OtherBLUE CROSS BLUE SHIELD
AL009931864Medicare ID - Type UnspecifiedMEDICARE
AL1210952OtherUNITED HEALTH CARE