Individual
KENNETH ROBERT DAUGHTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
PEUBLO AT BATH ST., SANTA BARBARA, CA 93105-4390
(805) 569-7279
(805) 569-8279
Mailing address
PO BOX 4219, ORANGE, CA 92863-4219
(714) 571-5000
(714) 571-5055
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A74865
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A748650
BLUE SHIELD OF CA
—
05
—
00A748650
—
CA
01
—
050396CI06756
TRAILBLAZER
—
01
—
P00275037
RAILROAD MEDICARE
—
Enumeration date
07/18/2005
Last updated
08/18/2008
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