Healthcare Provider Details

I. General information

NPI: 1922566694
Provider Name (Legal Business Name): ROBIN F MACDOUGALL, D.O., P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5533 E BELL RD STE 109
SCOTTSDALE AZ
85254-1256
US

IV. Provider business mailing address

PO BOX 10370
GLENDALE AZ
85318-0370
US

V. Phone/Fax

Practice location:
  • Phone: 602-788-4200
  • Fax: 623-547-6863
Mailing address:
  • Phone: 619-838-7975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBIN FRED MACDOUGALL
Title or Position: BUSINESS OWNER
Credential: D.O.
Phone: 602-788-4200