MEDICARE: DAVID DOUGLASS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	9900477	NC
2	2080P0207X	Pediatric Hematology & Oncology Physician	E-12032	AR
3	208000000X	Pediatrics Physician	E-12032	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	31605	OTHER	NC	PARTNERS MEDICARE CHOICE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	895159	OTHER	NC	MAMSI
2	562034548	OTHER	NC	GROUP TAX ID
4	1216X	OTHER	NC	BCBS
5	7428011	OTHER	NC	AETNA
6	88655	OTHER	NC	MEDCOST
7	23702	OTHER	NC	WELLPATH
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639145741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID DOUGLASS MD

Provider Business Mailing Address
First Line	:	1 CHILDRENS WAY # 653
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72202-3500
Country	:	US
Telephone Number	:	501-364-1100
Fax Number	:	501-364-4082

Provider Business Practice Location Address
First Line	:	1 CHILDRENS WAY # 512-10
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72202-3500
Country	:	US
Telephone Number	:	501-364-1494
Fax Number	:	501-364-3634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	03/28/2023

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Directions to “ DAVID DOUGLASS MD” Practice Location

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