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General NPI Number Information
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NPI Number | 1346200656
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Entity Type | Individual
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Provider Name | WILLIAM P DOUGLASS MD
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Gender | Male
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 303 N CLYDE MORRIS BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32114
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Country | US
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Telephone | 386-254-4139
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Fax | 386-258-8265
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Provider Business Mailing Address
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Address Line | 569 HEALTH BLVD SUITE A
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-1499
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Country | US
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Telephone | 386-258-7668
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Fax | 386-258-7671
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | ME0015015
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License Number State | FL
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