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Individual

DR. JOHN LEE MCDONOUGH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223
(334) 464-2497
Mailing address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8148

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
11938
AL
207V00000X
Obstetrics & Gynecology Physician
Primary
11938
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000038853
AL
01
38853
BCBS PROVIDER NUMBER
AL
Enumeration date
03/23/2006
Last updated
01/23/2019
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