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General NPI Number Information
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NPI Number | 1053574137
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Entity Type | Individual
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Provider Name | ROBERT JAMES DOUGLAS MD
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Gender | Male
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 13865 LOCUST LN
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City | NAMPA
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State | ID
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Zip | 83686-9367
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Country | US
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Telephone | 208-989-4991
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Fax |
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Provider Business Mailing Address
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Address Line | 2510 INAGUA AVE N/A
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City | COCONUT GROVE
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State | FL
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Zip | 33133-3812
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Country | US
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Telephone | 208-989-4991
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | ME13225
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME13225
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License Number State | FL
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