Provider Demographics
NPI:1255482360
Name:MOUGEY, ADAM M (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:M
Last Name:MOUGEY
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 1:1210 GARDNER WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9300
Mailing Address - Country:US
Mailing Address - Phone:503-715-7708
Mailing Address - Fax:
Practice Address - Street 1:2860 CREEKSIDE CIR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8442
Practice Address - Country:US
Practice Address - Phone:541-779-8367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6354312-1205207R00000X
NMMD2012-0188207RG0100X
ORMD161325207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine