Healthcare Provider Details

I. General information

NPI: 1689257214
Provider Name (Legal Business Name): RILEY MCDOUGALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2021
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 W ORANGE GROVE RD BLDG 1
TUCSON AZ
85704-1135
US

IV. Provider business mailing address

1845 W ORANGE GROVE RD BLDG 1
TUCSON AZ
85704-1135
US

V. Phone/Fax

Practice location:
  • Phone: 520-420-2875
  • Fax: 520-762-4890
Mailing address:
  • Phone: 520-420-2875
  • Fax: 520-762-4890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberR78643
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR78643
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number80211
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: