Provider Demographics
NPI:1932302536
Name:DUGI, DANIEL DAVID III (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DAVID
Last Name:DUGI
Suffix:III
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 1:3303 SW BOND AVENUE
Mailing Address - Street 2:DIVISION OF UROLOGY CH-10-U
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-7708
Mailing Address - Country:US
Mailing Address - Phone:214-590-8058
Mailing Address - Fax:
Practice Address - Street 1:3303 SW BOND AVENUE
Practice Address - Street 2:DIVISION OF UROLOGY
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-494-8470
Practice Address - Fax:503-346-1501
Is Sole Proprietor?:No
Enumeration Date:2007-06-09
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXM9263208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP2-0018417OtherINSTITUTIONAL PERMIT
TX194526301Medicaid