=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245354307
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JENNIFER T MCGAUGHY DO PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2007
-----------------------------------------------------
Last Update Date | 08/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3101 GARRETT DR
-----------------------------------------------------
City | PERRYTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79070-5323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-435-3606
-----------------------------------------------------
Fax | 806-435-2067
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 822
-----------------------------------------------------
City | PERRYTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79070-0822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-435-3606
-----------------------------------------------------
Fax | 806-435-2067
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JENNIFER T MCGAUGHY
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 806-434-0622
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | L9981
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------