Provider Demographics
NPI:1144275355
Name:MCDOUGAL, PEDRO E (MD FACP)
Entity type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:E
Last Name:MCDOUGAL
Suffix:
Gender:M
Credentials:MD FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 S JAMES ST SUITE B
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596
Mailing Address - Country:US
Mailing Address - Phone:956-968-1621
Mailing Address - Fax:956-447-8626
Practice Address - Street 1:1010 JAMES ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6654
Practice Address - Country:US
Practice Address - Phone:956-968-1621
Practice Address - Fax:956-447-8626
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9202207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122375205Medicaid
TX122375205Medicaid
TX8A1243Medicare PIN