Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 6844 | NC |
NPI | 1033299060 |
---|---|
Provider Name | Dr. Roger Alexander Mcdougal |
First Address | Durham, NC 27713-8684 |
Second Address | Durham, NC 27713-8684 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 08/07/2007 |