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General NPI Number Information
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NPI Number | 1679986277
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Entity Type | Individual
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Provider Name | STEPHANIE DOUGLAS M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/11/2014
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 450 BROADWAY ST
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City | REDWOOD CITY
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State | CA
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Zip | 94063-3132
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Country | US
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Telephone | 650-723-5643
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Fax |
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Provider Business Mailing Address
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Address Line | 430 BROADWAY STREET, MC: 6342 PAVILION C, 4TH FLOOR
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City | REDWOOD CITY
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State | CA
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Zip | 94063-3132
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Country | US
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Telephone | 650-721-7669
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Fax | 650-721-3470
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 2021025372
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 01084127A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ETL-6027
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 198522
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License Number State | CA
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