MEDICARE: DOUGLAS FUJAWA DDS, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2901021229	MI
2	1223P0221X	Pediatric Dentistry	DN23156	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336541135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS FUJAWA DDS, MS

Provider Business Mailing Address
First Line	:	3123 W 23RD ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-1828
Country	:	US
Telephone Number	:	850-481-1969
Fax Number	:

Provider Business Practice Location Address
First Line	:	3123 W 23RD ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-1828
Country	:	US
Telephone Number	:	850-481-1969
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2014
Last Update Date	:	04/19/2018

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