Provider Demographics
NPI:1679574099
Name:DRAGUN, MICHAEL JOHN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:DRAGUN
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 1:2706 W CUTHBERT AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-3887
Mailing Address - Country:US
Mailing Address - Phone:432-687-0311
Mailing Address - Fax:432-687-0312
Practice Address - Street 1:2706 W CUTHBERT AVE STE C
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3887
Practice Address - Country:US
Practice Address - Phone:432-687-0311
Practice Address - Fax:432-687-0312
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6927208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115614304Medicaid
F94335Medicare UPIN
340010233Medicare ID - Type UnspecifiedRAILROAD
TX8D3481Medicare ID - Type Unspecified