Provider Demographics
NPI:1568973717
Name:DOUGAN, GREGORY THOMAS (PA-C)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:THOMAS
Last Name:DOUGAN
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:303 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2368
Practice Address - Country:US
Practice Address - Phone:812-358-7705
Practice Address - Fax:888-254-0293
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2023-07-07
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Provider Licenses
StateLicense IDTaxonomies
IN10002391A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant