Healthcare Provider Details

I. General information

NPI: 1811196611
Provider Name (Legal Business Name): DOUGLAS PAIGE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 N PIEDRAS ST
EL PASO TX
79920-5001
US

IV. Provider business mailing address

5005 N PIEDRAS ST
EL PASO TX
79920-5001
US

V. Phone/Fax

Practice location:
  • Phone: 915-569-2180
  • Fax: 915-569-1919
Mailing address:
  • Phone: 915-569-2180
  • Fax: 915-569-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: