Basic Information
| Provider Information | |||||||||
| NPI: | 1689627531 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR. GUY T. MCDOUGAL AND ASSOCIATES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3228 E FOUNTAIN ST | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852135527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808543310 | ||||||||
| FaxNumber: | 4808541157 | ||||||||
| Practice Location | |||||||||
| Address1: | 1121 S GILBERT RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852045235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808543310 | ||||||||
| FaxNumber: | 4808541157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 10/10/2011 | ||||||||
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| AuthorizedOfficialLastName: | MCDOUGAL | ||||||||
| AuthorizedOfficialFirstName: | GUY | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4808543310 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 691 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.