Provider Demographics
NPI:1073623153
Name:MCDONAGH, DENNIS JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:JOSEPH
Last Name:MCDONAGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2636 FOREST CIRCLE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257
Mailing Address - Country:US
Mailing Address - Phone:904-549-8228
Mailing Address - Fax:904-549-8230
Practice Address - Street 1:425 N LEE ST
Practice Address - Street 2:STE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257
Practice Address - Country:US
Practice Address - Phone:904-549-8228
Practice Address - Fax:904-549-8230
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039836207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08658OtherWELLCARE MEDICARE
FL15688OtherBLUE CROSS BLUE SHIELD
FL210079OtherAVMED
FL5082045OtherAETNA
FL1870729005OtherCIGNA
FL08658OtherWELLCARE MEDICARE
D52700Medicare UPIN