1477520153 NPI number — SANGEETA JAIN DOSHI MD

Table of content: SANGEETA JAIN DOSHI MD (NPI 1477520153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477520153 NPI number — SANGEETA JAIN DOSHI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOSHI
Provider First Name:
SANGEETA
Provider Middle Name:
JAIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOSHI
Provider Other First Name:
SANGEETA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1477520153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2812 HARTFORD HWY STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36305-4927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-712-1170
Provider Business Mailing Address Fax Number:
334-460-8391

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1970 ANDREWS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OZARK
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36360-3726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-774-1555
Provider Business Practice Location Address Fax Number:
334-443-0213
Provider Enumeration Date:
03/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  21397 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 051502397 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51502397 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P00136563 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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