Provider Demographics
NPI:1366543720
Name:MIDDAUGH, JOHN PHILIP (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PHILIP
Last Name:MIDDAUGH
Suffix:
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 1:613 POINT RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8810
Mailing Address - Country:US
Mailing Address - Phone:702-629-5289
Mailing Address - Fax:
Practice Address - Street 1:613 POINT RIDGE PL
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-8810
Practice Address - Country:US
Practice Address - Phone:702-629-5289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV128502083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine