Healthcare Provider Details

I. General information

NPI: 1942289426
Provider Name (Legal Business Name): DOUGLAS M OKAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5211 W BROAD ST STE 101
RICHMOND VA
23230-3000
US

IV. Provider business mailing address

5211 W BROAD ST STE 101
RICHMOND VA
23230-3000
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-3025
  • Fax: 804-288-8843
Mailing address:
  • Phone: 42-883-0258
  • Fax: 804-288-8843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101231188
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number0101231188
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: