Basic Information
| Provider Information | |||||||||
| NPI: | 1932302536 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUGI | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3303 SW BOND AVENUE | ||||||||
| Address2: | DIVISION OF UROLOGY CH-10-U | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972397708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2145908058 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3303 SW BOND AVENUE | ||||||||
| Address2: | DIVISION OF UROLOGY | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034948470 | ||||||||
| FaxNumber: | 5033461501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2007 | ||||||||
| LastUpdateDate: | 07/01/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208800000X | M9263 | TX | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | BP2-0018417 | 01 | INSTITUTIONAL PERMIT | OTHER | 194526301 | 05 | TX | MEDICAID |