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General NPI Number Information
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NPI Number | 1497750731
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Entity Type | Individual
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Provider Name | SUE ANN DOUGLAS MD
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Gender | Female
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 04/01/2020
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Provider Practice Location Address
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Address Line | 2001 SHAWNEE MISSION PKWY STE 130
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City | MISSION WOODS
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State | KS
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Zip | 66205-2060
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Country | US
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Telephone | 913-228-2000
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Fax | 855-354-0963
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Provider Business Mailing Address
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Address Line | 2001 SHAWNEE MISSION PKWY STE 130
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City | MISSION WOODS
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State | KS
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Zip | 66205-2060
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Country | US
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Telephone | 913-228-2000
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Fax | 855-354-0963
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | M7958
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License Number State | TX
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