Provider Demographics
NPI:1982701462
Name:MCGOUGH, BILLY WAYNE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:BILLY
Middle Name:WAYNE
Last Name:MCGOUGH
Suffix:JR
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:805 SAINT VINCENTS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1636
Mailing Address - Country:US
Mailing Address - Phone:205-939-3699
Mailing Address - Fax:205-939-0989
Practice Address - Street 1:805 SAINT VINCENTS DR
Practice Address - Street 2:SUITE100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1636
Practice Address - Country:US
Practice Address - Phone:205-939-3699
Practice Address - Fax:205-939-0989
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NHRT-1461207X00000X
ALMD.30316207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL130923Medicaid
AL130923Medicaid