Provider Demographics
NPI:1063945723
Name:MCDOUGLE, REBECCA MAY (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MAY
Last Name:MCDOUGLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MAY
Other - Last Name:SALMONSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8100 42ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55427-1107
Mailing Address - Country:US
Mailing Address - Phone:763-581-5700
Mailing Address - Fax:763-581-5701
Practice Address - Street 1:8100 42ND AVE N
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55427-1107
Practice Address - Country:US
Practice Address - Phone:763-581-5700
Practice Address - Fax:763-581-5701
Is Sole Proprietor?:No
Enumeration Date:2017-04-09
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN68270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine