Provider Demographics
NPI:1053496141
Name:DUGGER CHILDRENS CLINIC
Entity Type:Organization
Organization Name:DUGGER CHILDRENS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:DUGGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FAAP
Authorized Official - Phone:228-818-2450
Mailing Address - Street 1:1800 GOVERNMENT ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3931
Mailing Address - Country:US
Mailing Address - Phone:228-818-2450
Mailing Address - Fax:228-818-2451
Practice Address - Street 1:1800 GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3931
Practice Address - Country:US
Practice Address - Phone:228-818-2450
Practice Address - Fax:228-818-2451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS069092080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04353701Medicaid
MS412723908DOtherBLUE CROSS BLUE SHIELD