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General NPI Number Information
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NPI Number | 1336311299
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Entity Type | Organization
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Legal Business Name | DONALD S. DOUGLAS, M.D.,
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 3510 RICHMOND RD STE 100
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City | TEXARKANA
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State | TX
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Zip | 75503-0712
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Country | US
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Telephone | 903-831-3033
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Fax | 903-831-3032
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Provider Business Mailing Address
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Address Line | 3510 RICHMOND RD STE 100
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City | TEXARKANA
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State | TX
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Zip | 75503-0712
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Country | US
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Telephone | 903-831-3033
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Fax | 903-831-3032
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Authorized Official
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Title or Position | OWNER
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Name | DONALD STRATTON DOUGLAS
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Credential | M.D.
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Telephone | 903-831-3033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | K9258
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | K9258
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License Number State | TX
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