Provider Demographics
NPI:1649327271
Name:MCDOUGAL, WILLARD BOYD (PA - CERTIFIED)
Entity type:Individual
Prefix:MR
First Name:WILLARD
Middle Name:BOYD
Last Name:MCDOUGAL
Suffix:
Gender:M
Credentials:PA - CERTIFIED
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PSC 80
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96367-9998
Mailing Address - Country:US
Mailing Address - Phone:316-630-4780
Mailing Address - Fax:
Practice Address - Street 1:18TH MDG/SGHQ
Practice Address - Street 2:KADENA AIR FORCE BASE
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96367-9998
Practice Address - Country:US
Practice Address - Phone:316-630-4780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant