MEDICARE: PATRICK HENRY MCDONOUGH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	Q6655	TX

General Provider Information

NPI Number	:	1023374519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK HENRY MCDONOUGH

Provider Business Mailing Address
First Line	:	6162 E MOCKINGBIRD LN
Second Line	:	STE. 120
City	:	DALLAS
State	:	TX
Zip	:	75214-2697
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6162 E MOCKINGBIRD LN
Second Line	:	SUITE 120
City	:	DALLAS
State	:	TX
Zip	:	75214-2697
Country	:	US
Telephone Number	:	214-463-8328
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2012
Last Update Date	:	08/26/2016

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