Provider Demographics
NPI:1598702086
Name:MACDOUGALL, ROBIN F (DO)
Entity Type:Individual
Prefix:MR
First Name:ROBIN
Middle Name:F
Last Name:MACDOUGALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4626 E. SHEA BLVD
Mailing Address - Street 2:SUITE C230
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028
Mailing Address - Country:US
Mailing Address - Phone:602-314-5119
Mailing Address - Fax:602-368-4071
Practice Address - Street 1:4626 E. SHEA BLVD
Practice Address - Street 2:SUITE C230
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028
Practice Address - Country:US
Practice Address - Phone:602-314-5119
Practice Address - Fax:602-368-4071
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ2830207QS0010X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF22964Medicare UPIN