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General NPI Number Information
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NPI Number | 1811990138
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Entity Type | Organization
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Legal Business Name | MICHAEL B. DOUGHTY
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 10/31/2016
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Provider Practice Location Address
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Address Line | 901 S. MOPAC EXPY. BUILDING 5 SUITE 220
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City | AUSTIN
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State | TX
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Zip | 78746
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Country | US
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Telephone | 512-327-0461
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Fax | 512-327-0916
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Provider Business Mailing Address
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Address Line | 901 S. MOPAC EXPY. BUILDING 5 SUITE 220
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City | AUSTIN
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State | TX
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Zip | 78746
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Country | US
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Telephone | 512-327-0461
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Fax | 512-327-0916
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | JOY WESTFALL
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Credential |
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Telephone | 512-327-0461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 17705
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License Number State | TX
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