Provider Demographics
NPI:1710946066
Name:DENNIS J. MCDONAGH, M.D., P.A.
Entity Type:Organization
Organization Name:DENNIS J. MCDONAGH, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:904-549-8228
Mailing Address - Street 1:2636 FOREST CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 N LEE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-1127
Practice Address - Country:US
Practice Address - Phone:904-549-8228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039836207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1870729005OtherCIGNA PROVIDER NUMBER
210079OtherAVMED PROVIDER NUMBER
3122189OtherAETNA HMO PROVIDER NUMBER
15688AOtherBCBS PROVIDER NUMBER
5082045OtherAETNA PROVIDER NUMBER
210079OtherAVMED PROVIDER NUMBER
15688AMedicare ID - Type UnspecifiedMEDICARE