1003923541 NPI number — ROBIN F. MACDOUGALL, D.O.,P.C.

Table of content: (NPI 1003923541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003923541 NPI number — ROBIN F. MACDOUGALL, D.O.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBIN F. MACDOUGALL, D.O.,P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003923541
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5310 W THUNDERBIRD RD
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85306-4706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-548-6500
Provider Business Mailing Address Fax Number:
602-863-0232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4921 EAST BELL ROAD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85254-2666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-548-6500
Provider Business Practice Location Address Fax Number:
602-993-0054
Provider Enumeration Date:
08/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROBERTSON
Authorized Official First Name:
DEBI
Authorized Official Middle Name:
J
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
602-548-6500

Provider Taxonomy Codes

  • Taxonomy code: 204D00000X , with the licence number:  2830 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 2830 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)