Provider Demographics
NPI:1467629709
Name:NUGENT, RODERICK MATHEW (M D)
Entity Type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:MATHEW
Last Name:NUGENT
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11508 ROYALSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2914
Mailing Address - Country:US
Mailing Address - Phone:214-365-9417
Mailing Address - Fax:214-365-8095
Practice Address - Street 1:11508 ROYALSHIRE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2914
Practice Address - Country:US
Practice Address - Phone:214-365-9417
Practice Address - Fax:214-365-8095
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD-4249207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC-19961Medicare UPIN