Healthcare Provider Details

I. General information

NPI: 1669667556
Provider Name (Legal Business Name): GRACE CASTRO DOUGAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 W. MARTIN LUTHER KING JR. BLVD 3RD FLOOR MEDICAL ARTS BUILDING
TAMPA FL
33607
US

IV. Provider business mailing address

3001 W. MARTIN LUTHER KING JR. BLVD 3RD FLOOR MEDICAL ARTS BUILDING
TAMPA FL
33607
US

V. Phone/Fax

Practice location:
  • Phone: 813-554-8420
  • Fax: 813-554-8377
Mailing address:
  • Phone: 813-554-8420
  • Fax: 813-554-8377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberME108000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: