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General NPI Number Information
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NPI Number | 1053416313
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Entity Type | Individual
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Provider Name | DONALD R. DOUGLAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 06/09/2020
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Provider Practice Location Address
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Address Line | 2537 LARKIN RD
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City | LEXINGTON
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State | KY
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Zip | 40503-3201
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Country | US
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Telephone | 270-554-5114
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Fax | 270-215-4834
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Provider Business Mailing Address
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Address Line | 733 CHINKAPIN DRIVE STE 2
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City | NICHOLASVILLE
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State | KY
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Zip | 40356
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Country | US
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Telephone | 859-223-0721
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 26259
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 26259
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License Number State | KY
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