Provider Demographics
NPI:1760566954
Name:DUGAS, JEFFREY ALAN SR (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:DUGAS
Suffix:SR
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 1:800 S WELLS ST STE M15
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4559
Mailing Address - Country:US
Mailing Address - Phone:312-255-1580
Mailing Address - Fax:312-255-0783
Practice Address - Street 1:800 S WELLS ST STE M15
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4559
Practice Address - Country:US
Practice Address - Phone:312-255-1580
Practice Address - Fax:312-255-0783
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071610207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036071610Medicaid
IL036071610Medicaid
ILK26227Medicare PIN