Healthcare Provider Details

I. General information

NPI: 1952375511
Provider Name (Legal Business Name): JAMES W DOUGLAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 W 15TH ST SUITE 425
PLANO TX
75093-5841
US

IV. Provider business mailing address

4001 W 15TH ST SUITE 425
PLANO TX
75093-5841
US

V. Phone/Fax

Practice location:
  • Phone: 972-612-2500
  • Fax: 972-612-9601
Mailing address:
  • Phone: 972-612-2500
  • Fax: 972-612-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberH7723
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: