Basic Information
| Provider Information | |||||||||
| NPI: | 1689986507 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOUGHERTY | ||||||||
| FirstName: | ALEXIS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1206 | ||||||||
| Address2: | |||||||||
| City: | GOLETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931161206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059643838 | ||||||||
| FaxNumber: | 8056833400 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 E ARRELLAGA ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931032275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056875538 | ||||||||
| FaxNumber: | 8056875530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2010 | ||||||||
| LastUpdateDate: | 02/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0101X | A126933 | CA | N | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery | 390200000X | BP2-0036384 | TX | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207N00000X | A126933 | CA | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.