Provider Demographics
NPI:1104165091
Name:CAPITAL ARTHROSCOPY SPORTS MEDICINE TRAUMA SURGERY PA
Entity type:Organization
Organization Name:CAPITAL ARTHROSCOPY SPORTS MEDICINE TRAUMA SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DUGGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:512-364-6562
Mailing Address - Street 1:PO BOX 302405
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-0041
Mailing Address - Country:US
Mailing Address - Phone:512-720-8215
Mailing Address - Fax:281-254-7864
Practice Address - Street 1:4112 LINKS LN
Practice Address - Street 2:SUITE 101
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3901
Practice Address - Country:US
Practice Address - Phone:512-720-8215
Practice Address - Fax:281-254-7864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9262207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX271190Medicare UPIN