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General NPI Number Information
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NPI Number | 1467629709
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Entity Type | Individual
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Provider Name | RODERICK MATHEW NUGENT M. D.
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Gender | Male
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 11508 ROYALSHIRE DR
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City | DALLAS
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State | TX
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Zip | 75230-2914
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Country | US
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Telephone | 214-365-9417
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Fax | 214-365-8095
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Provider Business Mailing Address
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Address Line | 11508 ROYALSHIRE DR
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City | DALLAS
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State | TX
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Zip | 75230-2914
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Country | US
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Telephone | 214-365-9417
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Fax | 214-365-8095
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | D-4249
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License Number State | TX
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