Healthcare Provider Details

I. General information

NPI: 1023200383
Provider Name (Legal Business Name): RONALD MCGAUGH JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15004 AVERY RANCH BLVD SUITE #105
AUSTIN TX
78717-4600
US

IV. Provider business mailing address

15004 AVERY RANCH BLVD SUITE #105
AUSTIN TX
78717-4600
US

V. Phone/Fax

Practice location:
  • Phone: 512-528-7420
  • Fax: 512-528-7421
Mailing address:
  • Phone: 512-528-7420
  • Fax: 512-528-7421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM6754
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: