Healthcare Provider Details

I. General information

NPI: 1487645081
Provider Name (Legal Business Name): YON D OUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1969 W HART RD
BELOIT WI
53511-2230
US

IV. Provider business mailing address

3005 RIVERSIDE DR STE 206
BELOIT WI
53511-1500
US

V. Phone/Fax

Practice location:
  • Phone: 608-362-7444
  • Fax:
Mailing address:
  • Phone: 608-362-7444
  • Fax: 608-362-0417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25164
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: