Provider Demographics
NPI:1538249099
Name:ENGH, DOUGLAS MARSHALL (MD ,FACS, INC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:MARSHALL
Last Name:ENGH
Suffix:
Gender:M
Credentials:MD ,FACS, INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25775 MCBEAN PKWY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-3708
Mailing Address - Country:US
Mailing Address - Phone:661-253-5000
Mailing Address - Fax:661-259-9467
Practice Address - Street 1:25775 MCBEAN PKWY
Practice Address - Street 2:SUITE 208
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-3708
Practice Address - Country:US
Practice Address - Phone:661-253-5000
Practice Address - Fax:661-259-9467
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG50142207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G501421Medicaid
CAA92952Medicare UPIN
CAAR832Medicare PIN
CA00G501421Medicaid
CA180019067Medicare PIN