Healthcare Provider Details

I. General information

NPI: 1902487218
Provider Name (Legal Business Name): SCOTT JACKSON DOUGLAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 RIVER PARK DR STE 2000
SACRAMENTO CA
95815-4601
US

IV. Provider business mailing address

1535 RIVER PARK DR STE 2000
SACRAMENTO CA
95815-4601
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2680
  • Fax: 916-319-7048
Mailing address:
  • Phone: 916-734-2680
  • Fax: 916-319-7048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA208340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: