Provider Demographics
NPI:1982806352
Name:MCDONOUGH OBGYN
Entity Type:Organization
Organization Name:MCDONOUGH OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-347-4646
Mailing Address - Street 1:207 E WATTS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-1801
Mailing Address - Country:US
Mailing Address - Phone:334-347-4646
Mailing Address - Fax:334-347-8719
Practice Address - Street 1:207 E WATTS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-1801
Practice Address - Country:US
Practice Address - Phone:334-347-4646
Practice Address - Fax:334-347-8719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3908174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL04173OtherPROVIDER NUMBER
AL1023077013OtherINDIVIDUAL NPI NUMBER
AL510-04173OtherBCBS PROVIDER NUMBER
AL04173OtherPROVIDER NUMBER
ALC74897Medicare UPIN