1003893652 NPI number — DR. FREDERICK T DUGGAN M.D.

Table of content: DR. FREDERICK T DUGGAN M.D. (NPI 1003893652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003893652 NPI number — DR. FREDERICK T DUGGAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUGGAN
Provider First Name:
FREDERICK
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1003893652
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 22ND AVE
Provider Second Line Business Mailing Address:
MEDICAL TOWERS III
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39301-3223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-483-5322
Provider Business Mailing Address Fax Number:
601-693-8081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 22ND AVE
Provider Second Line Business Practice Location Address:
MEDICAL TOWERS III
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39301-3223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-483-5322
Provider Business Practice Location Address Fax Number:
601-581-2289
Provider Enumeration Date:
12/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  11716 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00014341 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com