Provider Demographics
NPI:1174277289
Name:MCDOUGAL, TIMOTHY (CNIM)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:MCDOUGAL
Suffix:
Gender:M
Credentials:CNIM
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 75256
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-5256
Mailing Address - Country:US
Mailing Address - Phone:281-346-3480
Mailing Address - Fax:281-462-4106
Practice Address - Street 1:1801 ROYAL LN STE 908
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-7502
Practice Address - Country:US
Practice Address - Phone:281-346-3480
Practice Address - Fax:281-462-4106
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic