Provider Demographics
NPI:1295703049
Name:MCDOUGAL, EMORY GARY (MD)
Entity type:Individual
Prefix:DR
First Name:EMORY
Middle Name:GARY
Last Name:MCDOUGAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1899 TATE BLVD SE
Mailing Address - Street 2:SUITE 2106
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4200
Mailing Address - Country:US
Mailing Address - Phone:828-322-9105
Mailing Address - Fax:828-328-4999
Practice Address - Street 1:1899 TATE BLVD SE
Practice Address - Street 2:SUITE 2106
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4200
Practice Address - Country:US
Practice Address - Phone:828-322-9105
Practice Address - Fax:828-328-4999
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2013-09-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC26127208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC56268OtherNCBCBS
NC5950199Medicaid
C85418Medicare UPIN
NC5950199Medicaid
NC56268OtherNCBCBS