Basic Information
| Provider Information | |||||||||
| NPI: | 1346200359 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUGAN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 602478 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282602478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044469987 | ||||||||
| FaxNumber: | 7043501113 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 ROZZELLES FERRY RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282084228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044469987 | ||||||||
| FaxNumber: | 7043501113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 05/12/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 200201241 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 39880 | SC | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1346200359 | 05 | NC | MEDICAID | NC2202 | 05 | SC | MEDICAID |