Healthcare Provider Details

I. General information

NPI: 1265525802
Provider Name (Legal Business Name): JAMES EDWARD DOUGLAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 NW SAMARITAN DR STE 215
CORVALLIS OR
97330-3893
US

IV. Provider business mailing address

PO BOX 1189
CORVALLIS OR
97339-1189
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-5235
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD22844
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: