MEDICARE: JESSICA DUGGAN DPM PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	0763	AZ

General Provider Information

NPI Number	:	1134560097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESSICA DUGGAN DPM PC

Provider Business Mailing Address
First Line	:	2741 S 8TH AVE
Second Line	:	SUITE C
City	:	YUMA
State	:	AZ
Zip	:	85364-7154
Country	:	US
Telephone Number	:	928-726-6295
Fax Number	:

Provider Business Practice Location Address
First Line	:	2741 S 8TH AVE
Second Line	:	SUITE C
City	:	YUMA
State	:	AZ
Zip	:	85364-7154
Country	:	US
Telephone Number	:	928-726-6295
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JESSICA DUGGAN
Credential	:	DPM
Telephone Number	:	928-726-6295

Provider Enumeration Date	:	07/08/2013
Last Update Date	:	05/03/2016

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