Provider Demographics
NPI:1023073988
Name:MCDOUGAL, MARY J
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:MCDOUGAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 SUNCHASE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-0500
Mailing Address - Country:US
Mailing Address - Phone:904-564-2001
Mailing Address - Fax:904-564-2001
Practice Address - Street 1:1832 SUNCHASE CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-0500
Practice Address - Country:US
Practice Address - Phone:904-564-2001
Practice Address - Fax:904-564-2001
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor