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General NPI Number Information
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NPI Number | 1477761914
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Entity Type | Organization
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Legal Business Name | DOUGLAS W ANKROM, MD, INC
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 01/06/2011
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Provider Practice Location Address
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Address Line | 680 GUZZI LN STE 205
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City | SONORA
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State | CA
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Zip | 95370-5288
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Country | US
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Telephone | 209-533-3321
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Fax | 209-533-3118
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Provider Business Mailing Address
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Address Line | 680 GUZZI LN STE 205
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City | SONORA
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State | CA
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Zip | 95370-5288
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Country | US
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Telephone | 209-533-3321
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Fax | 209-533-3118
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Authorized Official
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Title or Position | PRESIDENT
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Name | DOUGLAS WARREN ANKROM
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Credential | M.D,
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Telephone | 209-533-3321
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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 | A52517
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License Number State | CA
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