Provider Demographics
NPI:1578563847
Name:DUGAL, JOHN CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:DUGAL
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 1:501 W SAINT MARY BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-4693
Mailing Address - Country:US
Mailing Address - Phone:337-470-4801
Mailing Address - Fax:337-470-4840
Practice Address - Street 1:501 W SAINT MARY BLVD STE 320
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4693
Practice Address - Country:US
Practice Address - Phone:337-470-4801
Practice Address - Fax:337-470-4840
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011865207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1148237Medicaid
LA51573Medicare PIN
LAB89455Medicare UPIN