1760666481 NPI number — E GARY MCDOUGAL, MD, PLLC

Table of content: (NPI 1760666481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760666481 NPI number — E GARY MCDOUGAL, MD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
E GARY MCDOUGAL, MD, PLLC
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:
1760666481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1899 TATE BLVD SE
Provider Second Line Business Mailing Address:
SUITE 2106
Provider Business Mailing Address City Name:
HICKORY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28602-4200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-322-9105
Provider Business Mailing Address Fax Number:
828-328-4999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1899 TATE BLVD SE
Provider Second Line Business Practice Location Address:
SUITE 2106
Provider Business Practice Location Address City Name:
HICKORY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28602-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-322-9105
Provider Business Practice Location Address Fax Number:
828-328-4999
Provider Enumeration Date:
12/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCDOUGAL
Authorized Official First Name:
E
Authorized Official Middle Name:
GARY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
828-322-9105

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  26127 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5950199 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 56268 . This is a "BCBS OF NC" identifier . This identifiers is of the category "OTHER".




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