Healthcare Provider Details

I. General information

NPI: 1114993755
Provider Name (Legal Business Name): DOUGLAS EUGENE HOUGHTON JR. ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE JACKSON HEALTH SYSTEM
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1219 PENNSYLVANIA AVE
MIAMI BEACH FL
33139-4415
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-1168
  • Fax: 305-585-5377
Mailing address:
  • Phone: 305-992-8910
  • Fax: 305-585-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number1919952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: