Healthcare Provider Details

I. General information

NPI: 1922099472
Provider Name (Legal Business Name): EDWARD B DUGAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: E BRIEN DUGAS MD

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 KENYON AVE UNIT 324
WAKEFIELD RI
02879-4253
US

IV. Provider business mailing address

70 KENYON AVE UNIT 324
WAKEFIELD RI
02879-4253
US

V. Phone/Fax

Practice location:
  • Phone: 401-782-1199
  • Fax: 401-782-1120
Mailing address:
  • Phone: 401-782-1199
  • Fax: 401-782-1120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberRI07261
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: