Provider Demographics
NPI:1144466996
Name:DUGAN, MICHAEL LYLE (BC-HIS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LYLE
Last Name:DUGAN
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 CROCKETT DRIVE
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-5906
Mailing Address - Country:US
Mailing Address - Phone:325-641-1825
Mailing Address - Fax:325-641-0716
Practice Address - Street 1:2410 CROCKETT DR STE A
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5981
Practice Address - Country:US
Practice Address - Phone:325-641-1825
Practice Address - Fax:325-641-0716
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50122231H00000X, 235Z00000X, 237600000X
TX50098237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter