Healthcare Provider Details

I. General information

NPI: 1134609852
Provider Name (Legal Business Name): DOUGLAS ALLAN DUNAGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 N MAIN ST
SAN ANGELO TX
76903-4077
US

IV. Provider business mailing address

902 N MAIN ST
SAN ANGELO TX
76903-4077
US

V. Phone/Fax

Practice location:
  • Phone: 325-655-7391
  • Fax: 325-653-1413
Mailing address:
  • Phone: 325-655-7391
  • Fax: 325-653-1413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2036929
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: