Healthcare Provider Details

I. General information

NPI: 1457702243
Provider Name (Legal Business Name): REBECCA DOUGLASS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HARRODSBURG RD STE B355
LEXINGTON KY
40504-3747
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-276-5262
  • Fax: 859-277-6509
Mailing address:
  • Phone: 606-330-7835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number05-45386
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number06045
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: