Healthcare Provider Details

I. General information

NPI: 1811969991
Provider Name (Legal Business Name): ALAN BRUCE DOUGLASS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

625 W. CITRACADO PARKWAY SUITE 108
ESCONDIDO CA
92025
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-7375
  • Fax: 619-532-5472
Mailing address:
  • Phone: 760-743-1431
  • Fax: 760-743-6455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberG75547
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: