Provider Demographics
NPI:1346200359
Name:DUGAN, JOHN JOSEPH JR (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:DUGAN
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 602478
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2478
Mailing Address - Country:US
Mailing Address - Phone:704-446-9987
Mailing Address - Fax:704-350-1113
Practice Address - Street 1:1801 ROZZELLES FERRY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-4228
Practice Address - Country:US
Practice Address - Phone:704-446-9987
Practice Address - Fax:704-350-1113
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2017-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC200201241207Q00000X
SC39880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1346200359Medicaid
SCNC2202Medicaid
NCNCK129BMedicare UPIN
NC1346200359Medicaid