Provider Demographics
NPI:1104889351
Name:DOUGH, ROBERT LYLE JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LYLE
Last Name:DOUGH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 WESTCHESTER DR
Mailing Address - Street 2:STE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7008
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:375 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5611
Practice Address - Country:US
Practice Address - Phone:336-625-4215
Practice Address - Fax:336-626-0919
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27449207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7929096Medicaid
NC29096OtherBCBS NC PROVIDER #
NC5027051OtherAETNA PROVIDER NUMBER
NC39623OtherMEDCOST PROVIDER NUMBER
NC22490OtherPARTNERS MEDICARE PROVIDE
NC7929096Medicaid
NC29096OtherBCBS NC PROVIDER #