Provider Demographics
NPI:1962516757
Name:GROGAN, DOUGALS REID JR (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGALS
Middle Name:REID
Last Name:GROGAN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:111 TORREY ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4800
Mailing Address - Country:US
Mailing Address - Phone:508-588-1200
Mailing Address - Fax:508-941-0497
Practice Address - Street 1:111 TORREY ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4800
Practice Address - Country:US
Practice Address - Phone:508-588-1200
Practice Address - Fax:508-941-0497
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2016-05-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA47811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB74406Medicare UPIN