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General NPI Number Information
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NPI Number | 1104027382
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Entity Type | Individual
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Provider Name | JESSE DUGGER
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Gender | Male
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 564 S DORA ST SUITE B2
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City | UKIAH
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State | CA
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Zip | 95482-5486
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Country | US
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Telephone | 707-467-9065
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2077
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City | UKIAH
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State | CA
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Zip | 95482-2077
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Country | US
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Telephone | 707-472-2922
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number |
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License Number State |
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