Healthcare Provider Details

I. General information

NPI: 1285654285
Provider Name (Legal Business Name): WILLIAM LADELL DOUGLAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 20TH ST SUITE B
HOPE AR
71801-8213
US

IV. Provider business mailing address

100 E 20TH ST SUITE B
HOPE AR
71801-8213
US

V. Phone/Fax

Practice location:
  • Phone: 870-777-2100
  • Fax: 870-777-4851
Mailing address:
  • Phone: 870-777-2100
  • Fax: 870-777-4851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberR4535
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: