Provider Demographics
NPI:1104862721
Name:MCCONNAUGHEY, DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:MCCONNAUGHEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8039
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-8039
Mailing Address - Country:US
Mailing Address - Phone:714-965-2500
Mailing Address - Fax:714-965-2581
Practice Address - Street 1:9900 TALBERT AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5153
Practice Address - Country:US
Practice Address - Phone:714-965-2500
Practice Address - Fax:714-965-2581
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68421207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA68421AMedicare ID - Type Unspecified
G89549Medicare UPIN