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General NPI Number Information
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NPI Number | 1639523665
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Entity Type | Individual
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Provider Name | MICHAEL STEPHEN DOUGLAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/15/2016
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 26520 CACTUS AVE
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City | MORENO VALLEY
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State | CA
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Zip | 92555-3927
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Country | US
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Telephone | 951-486-4574
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Fax |
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Provider Business Mailing Address
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Address Line | 11234 ANDERSON ST DEPARTMENT OF ANESTHESIOLOGY
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City | LOMA LINDA
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State | CA
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Zip | 92354-2804
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Country | US
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Telephone | 909-558-4389
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A151081
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License Number State | CA
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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 | A151081
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | A151081
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | A151081
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License Number State | CA
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