Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | J9202 | TX |
NPI | 1144275355 |
---|---|
Provider Name | Mr. Pedro E Mcdougal |
First Address | Weslaco, TX 78596 |
Second Address | Weslaco, TX 78596-6654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 30/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
122375205 | (05) | TX |
G13959 | (02) | TX |