Provider Demographics
NPI:1528164910
Name:DUGAN, ROBERT RUSSELL III
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RUSSELL
Last Name:DUGAN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9912 DIMITRIOS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-9564
Mailing Address - Country:US
Mailing Address - Phone:251-625-2215
Mailing Address - Fax:
Practice Address - Street 1:9912 DIMITRIOS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-9564
Practice Address - Country:US
Practice Address - Phone:251-625-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2963111N00000X
AL2236111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2272348Medicaid
OH2272348Medicaid
OHU88027Medicare UPIN