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General NPI Number Information
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NPI Number | 1699703975
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Entity Type | Individual
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Provider Name | SUSAN M DOUGLAS MD
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Gender | Female
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 3601 4TH ST
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City | LUBBOCK
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State | TX
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Zip | 79430-0002
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Country | US
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Telephone | 806-743-6759
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Fax |
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Provider Business Mailing Address
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Address Line | 250 N SHADELAND AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4959
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Country | US
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Telephone |
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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 | 01052790A
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License Number State | IN
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