Healthcare Provider Details

I. General information

NPI: 1134267966
Provider Name (Legal Business Name): DUGAN RADIOLOGY ASSOCIATES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9515 HOLY CROSS LN
BREESE IL
62230-3618
US

IV. Provider business mailing address

55 W PORT PLZ SUITE 300
SAINT LOUIS MO
63146-3109
US

V. Phone/Fax

Practice location:
  • Phone: 618-526-4511
  • Fax: 314-821-2180
Mailing address:
  • Phone: 314-548-4775
  • Fax: 314-548-4748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number042000918
License Number StateIL

VIII. Authorized Official

Name: MR. THOMAS B DOYLE
Title or Position: PRESIDENT
Credential: MD
Phone: 314-821-5600