Healthcare Provider Details

I. General information

NPI: 1578724555
Provider Name (Legal Business Name): MARK CHRISTOPHER DUGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2008
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W CHARLESTON BLVD 4TH FLOOR - PEDIATRIC CRITICAL CARE
LAS VEGAS NV
89102-2329
US

IV. Provider business mailing address

12216 CAPILLA REAL AVE
LAS VEGAS NV
89138-4543
US

V. Phone/Fax

Practice location:
  • Phone: 702-383-2420
  • Fax:
Mailing address:
  • Phone: 216-225-9852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.097064
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number067558
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number15904
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: