Healthcare Provider Details

I. General information

NPI: 1154384634
Provider Name (Legal Business Name): THOMAS JOSEPH DOUGLAS III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 01/10/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US NAVAL HOSPITAL NAPLES
FPO AA
09618
US

IV. Provider business mailing address

PSC 808 BOX 554
FPO AE
09618-0006
US

V. Phone/Fax

Practice location:
  • Phone: 314-629-6775
  • Fax:
Mailing address:
  • Phone: 516-298-7708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number250992
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101240254
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: