Individual
DR. JAMIE L MACDOUGALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
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
207N00000X
Dermatology Physician
Primary
G55441
CA
207ND0900X
Dermatopathology Physician
G55441
CA
207NP0225X
Pediatric Dermatology Physician
G55441
CA
207NS0135X
Procedural Dermatology Physician
G55441
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G55441
STATE LICENSE NUMBER
CA
Enumeration date
12/26/2005
Last updated
07/22/2009
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