Provider Demographics
NPI:1134560097
Name:JESSICA DUGGAN DPM PC
Entity type:Organization
Organization Name:JESSICA DUGGAN DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUGGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:928-726-6295
Mailing Address - Street 1:2741 S 8TH AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7154
Mailing Address - Country:US
Mailing Address - Phone:928-726-6295
Mailing Address - Fax:
Practice Address - Street 1:2741 S 8TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7154
Practice Address - Country:US
Practice Address - Phone:928-726-6295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0763213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty