Provider Demographics
NPI:1720861024
Name:DOGBEY, MYDEEM DOE
Entity Type:Individual
Prefix:
First Name:MYDEEM
Middle Name:DOE
Last Name:DOGBEY
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 1:860 SAGEBRUSH DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-7067
Mailing Address - Country:US
Mailing Address - Phone:214-212-1879
Mailing Address - Fax:
Practice Address - Street 1:7300 ELDORADO PKWY STE 230
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-7896
Practice Address - Country:US
Practice Address - Phone:972-372-4505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1098256363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care