Provider Demographics
NPI:1366686131
Name:DUGGER, GARY D
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:D
Last Name:DUGGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 HOBBS HWY
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-3401
Mailing Address - Country:US
Mailing Address - Phone:432-758-3656
Mailing Address - Fax:432-758-3117
Practice Address - Street 1:701 HOBBS HWY
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-3401
Practice Address - Country:US
Practice Address - Phone:432-758-3656
Practice Address - Fax:432-758-3117
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21327183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011193202Medicaid
TX3910440001Medicare NSC
TXPH0706Medicare PIN