Healthcare Provider Details

I. General information

NPI: 1932272986
Provider Name (Legal Business Name): TROY SCOTT DOUGLAS D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 12/20/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 DALE RD
MODESTO CA
95356-9718
US

IV. Provider business mailing address

3337 VINE CLIFF WAY
MODESTO CA
95355-8469
US

V. Phone/Fax

Practice location:
  • Phone: 209-735-6120
  • Fax:
Mailing address:
  • Phone: 209-551-3386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4641
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: