Healthcare Provider Details

I. General information

NPI: 1437773520
Provider Name (Legal Business Name): RAYMOND DOUGLAS, M.D., PHD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9675 BRIGHTON WAY STE 410
BEVERLY HILLS CA
90210-5192
US

IV. Provider business mailing address

9675 BRIGHTON WAY STE 410
BEVERLY HILLS CA
90210-5192
US

V. Phone/Fax

Practice location:
  • Phone: 310-363-8757
  • Fax: 310-363-8758
Mailing address:
  • Phone: 310-363-8757
  • Fax: 310-363-8758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN M MULLEN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 310-657-4302