Provider Demographics
NPI:1063457620
Name:DOCS MEDICAL GROUP INC
Entity type:Organization
Organization Name:DOCS MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PIYUSH
Authorized Official - Middle Name:K
Authorized Official - Last Name:DHANUKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-243-8667
Mailing Address - Street 1:PO BOX 994190
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-4190
Mailing Address - Country:US
Mailing Address - Phone:530-243-4967
Mailing Address - Fax:530-243-8742
Practice Address - Street 1:2510 AIRPARK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2449
Practice Address - Country:US
Practice Address - Phone:530-243-8667
Practice Address - Fax:530-243-8742
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOCS MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-18
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94647207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02408ZMedicare PIN