Provider Demographics
NPI:1992784235
Name:DUGDALE, WILLIAM ROY (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROY
Last Name:DUGDALE
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 1:809 WIMBLEDON CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-6137
Mailing Address - Country:US
Mailing Address - Phone:916-971-1253
Mailing Address - Fax:916-486-0841
Practice Address - Street 1:809 WIMBLEDON CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-6137
Practice Address - Country:US
Practice Address - Phone:916-971-1253
Practice Address - Fax:916-486-0841
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG11043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA011721675OtherRAILROAD MEDICARE
CA00G110430Medicaid
CA00G110430Medicaid
CA00G110430Medicare PIN