Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A69243 | CA |
N | 208600000X | Surgeon | A69243 | CA |
Y | 2086S0102X | Surgical Critical Care | A69243 | CA |
N | 2086S0127X | Trauma Surgeon | A69243 | CA |
NPI | 1205993813 |
---|---|
Provider Name | Dr. Jay Joseph Doucet |
First Address | San Diego, CA 92193-2410 |
Second Address | San Diego, CA 92103-9001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 14/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H58565 | (02) | CA |