Healthcare Provider Details

I. General information

NPI: 1891917779
Provider Name (Legal Business Name): DOUGLAS LIONEL CONSTANT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5741 BEE RIDGE RD STE 450
SARASOTA FL
34233-5081
US

IV. Provider business mailing address

8000 SR 64 E
BRADENTON FL
34212
US

V. Phone/Fax

Practice location:
  • Phone: 941-951-2663
  • Fax: 941-552-3312
Mailing address:
  • Phone: 941-792-1404
  • Fax: 941-795-1717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME108659
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME108659
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: