Provider Demographics
NPI:1124647573
Name:MCDONOUGH, WILLIAM PATRICK (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PATRICK
Last Name:MCDONOUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17191 ST LUKES WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-8043
Mailing Address - Country:US
Mailing Address - Phone:936-271-2555
Mailing Address - Fax:936-539-3635
Practice Address - Street 1:17191 ST LUKES WAY STE 200
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8043
Practice Address - Country:US
Practice Address - Phone:936-271-2555
Practice Address - Fax:936-271-2557
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT7990207Q00000X, 390200000X
TXBP10071371390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine