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NPI Code Detail

MEDICARE: XAVIER DOUGLAS MD

MEDICARE:   XAVIER  DOUGLAS  MD
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
1207Q00000XFamily Medicine Physician57.247348OH
22080S0010XPediatric Sports Medicine Physician66991AZ
3207Q00000XFamily Medicine Physician66991AZ

General Provider Information

NPI Number : 1427519982
Entity Type Code : Individual
Provider Name (Legal Business Name) : XAVIER DOUGLAS MD
Provider Business Mailing Address
First Line : 2108 E THOMAS RD STE 130
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-0008
Country : US
Telephone Number : 602-933-3124
Fax Number :
Provider Business Practice Location Address
First Line : 1919 E THOMAS RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-7710
Country : US
Telephone Number : 602-933-3033
Fax Number : 602-933-4311
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2019
Last Update Date : 07/25/2024

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Directions to “ XAVIER DOUGLAS MD” Practice Location

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