MEDICARE: DR. FREDERICK CARL MCDONOUGH D.O.

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	207Q00000X	Family Medicine Physician	H2586	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780677179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK CARL MCDONOUGH D.O.

Provider Business Mailing Address
First Line	:	2010 NINE RD
Second Line	:
City	:	BRADY
State	:	TX
Zip	:	76825-7210
Country	:	US
Telephone Number	:	325-597-2114
Fax Number	:	325-597-2155

Provider Business Practice Location Address
First Line	:	2010 NINE RD
Second Line	:
City	:	BRADY
State	:	TX
Zip	:	76825-7210
Country	:	US
Telephone Number	:	325-597-2114
Fax Number	:	325-597-2155

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	03/21/2011

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Directions to “ DR. FREDERICK CARL MCDONOUGH D.O.” Practice Location

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