Healthcare Provider Details

I. General information

NPI: 1003923541
Provider Name (Legal Business Name): ROBIN F. MACDOUGALL, D.O.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 EAST BELL ROAD SUITE 102
SCOTTSDALE AZ
85254-2666
US

IV. Provider business mailing address

5310 W THUNDERBIRD RD SUITE 203
GLENDALE AZ
85306-4706
US

V. Phone/Fax

Practice location:
  • Phone: 602-548-6500
  • Fax: 602-993-0054
Mailing address:
  • Phone: 602-548-6500
  • Fax: 602-863-0232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number2830
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2830
License Number StateAZ

VIII. Authorized Official

Name: DEBI J ROBERTSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 602-548-6500