Provider Demographics
NPI:1992853824
Name:DOANE, GREGORY C (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:C
Last Name:DOANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:4111 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:CA
Mailing Address - Zip Code:90201-4309
Mailing Address - Country:US
Mailing Address - Phone:323-271-6350
Mailing Address - Fax:323-271-3657
Practice Address - Street 1:1297 W HOBSONWAY
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1423
Practice Address - Country:US
Practice Address - Phone:760-921-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG794732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H47590Medicare UPIN