Active NPI
Douglas Christian Lidge, MD
- Psychiatry Physician
- Auburn, CA
National Provider Identifier
1508047168
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- G59192
- Practice address
- 1103 High Street
Suite 100
Auburn, CA 95603-5124 - Phone
- (530) 885-4673
- Fax
- (530) 888-9193
- NPI assigned
- Nov 23, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | G59192 | CA | Primary |
Addresses
Primary practice location
1103 High Street
Suite 100
Auburn, CA 95603-5124
Mailing address
1103 High Street
Suite 100
Auburn, CA 95603-5124
Phone (530) 885-4673
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G59192 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1195776000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323129600000",
"number": "1508047168",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1103 HIGH STREET",
"address_2": "SUITE 100",
"city": "AUBURN",
"state": "CA",
"postal_code": "956035124",
"telephone_number": "530-885-4673",
"fax_number": "530-888-9193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1103 HIGH STREET",
"address_2": "SUITE 100",
"city": "AUBURN",
"state": "CA",
"postal_code": "956035124",
"telephone_number": "530-885-4673",
"fax_number": "530-888-9193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIDGE",
"first_name": "DOUGLAS",
"middle_name": "CHRISTIAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-11-23",
"last_updated": "2011-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "G59192",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Auburn, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.