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NPI Code Detail

MEDICARE: BILLY JOE MCDOUGAL ATC

MEDICARE:   BILLY JOE MCDOUGAL  ATC
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
12255A2300XAthletic TrainerAL 213FL

General Provider Information

NPI Number : 1528185907
Entity Type Code : Individual
Provider Name (Legal Business Name) : BILLY JOE MCDOUGAL ATC
Provider Business Mailing Address
First Line : 6158 DAWNRIDGE RD S
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32277-1407
Country : US
Telephone Number : 904-744-3045
Fax Number :
Provider Business Practice Location Address
First Line : 2800 UNIVERSITY BLVD N
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32211-3321
Country : US
Telephone Number : 904-256-7421
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2007
Last Update Date : 07/08/2007

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Directions to “ BILLY JOE MCDOUGAL ATC” Practice Location

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