Basic Information
| Provider Information | |||||||||
| NPI: | 1457713414 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOUGAN | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | GREGORY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 636 EASTERN PKWY | ||||||||
| Address2: | APT 4A | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112133320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7073152407 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 E LIBERTY ST STE 555 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895012104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753481900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2016 | ||||||||
| LastUpdateDate: | 05/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | 20310 | NV | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.