Provider Demographics
NPI:1366435182
Name:DOURRON, HECTOR M (MD)
Entity type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:M
Last Name:DOURRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1109 BURLEYSON RD STE 202
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3094
Mailing Address - Country:US
Mailing Address - Phone:706-259-3336
Mailing Address - Fax:706-370-7715
Practice Address - Street 1:1109 BURLEYSON RD STE 202
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3094
Practice Address - Country:US
Practice Address - Phone:706-259-3336
Practice Address - Fax:706-370-7715
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0525562086S0129X
GA54489174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA080040114AMedicaid
GA77BBBLGMedicare ID - Type Unspecified
GA080040114AMedicaid