Provider Demographics
NPI:1598763302
Name:MCDOUGALL, WILLIAM (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:MCDOUGALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5299
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0102
Mailing Address - Country:US
Mailing Address - Phone:541-813-1797
Mailing Address - Fax:541-813-1801
Practice Address - Street 1:503 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9043
Practice Address - Country:US
Practice Address - Phone:707-954-8661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD024746207R00000X
CA20A7843207R00000X
ORDO24746207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274898Medicaid
OR274898Medicaid
OR93-0937095OtherCURRY HEALTH DISTRICT TAX I.D.
OR93-0937095OtherCURRY HEALTH DISTRICT TAX I.D.
OR0000ZGBDGOtherBROOKINGS MEDICAL CENTER MEDICARE PART B