Healthcare Provider Details

I. General information

NPI: 1316334634
Provider Name (Legal Business Name): KENDALL SAWYER DOUGLASS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD STE D330
MOBILE AL
36608-6758
US

IV. Provider business mailing address

6701 AIRPORT BLVD STE D330
MOBILE AL
36608-6758
US

V. Phone/Fax

Practice location:
  • Phone: 251-607-9797
  • Fax: 251-607-7696
Mailing address:
  • Phone: 251-607-9797
  • Fax: 251-607-7696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number309551
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number42416
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: