Provider Demographics
NPI:1235135823
Name:MACDOUGALL, JAMES BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRIAN
Last Name:MACDOUGALL
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 1460
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57402-1460
Mailing Address - Country:US
Mailing Address - Phone:605-226-2663
Mailing Address - Fax:605-226-0095
Practice Address - Street 1:701 8TH AVE NW
Practice Address - Street 2:STE A
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-1803
Practice Address - Country:US
Practice Address - Phone:605-226-2663
Practice Address - Fax:605-226-0095
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3324207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6400552Medicaid
SD6400552Medicaid
SD200027357Medicare PIN
E70344Medicare UPIN
SD1108470001Medicare NSC
ND14646Medicare PIN