Organization
JAMIE L MACDOUGALL MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMIE L MACDOUGALL MD (OWNER)
(310) 545-2900
Entity
Organization
Contact information
Practice address
828 MANHATTAN BEACH BLVD, MANHATTAN BEACH, CA 90266-4931
(310) 545-2900
(310) 545-2906
Mailing address
828 MANHATTAN BEACH BLVD, MANHATTAN BEACH, CA 90266-4931
(310) 545-2900
(310) 545-2906
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
G55441
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G55441
STATE LICENSE NUMBER
CA
Enumeration date
06/11/2008
Last updated
07/22/2009
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