MEDICARE: SUE ANN 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
1	207N00000X	Dermatology Physician	M7958	TX

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	:	1497750731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE ANN DOUGLAS MD

Provider Business Mailing Address
First Line	:	2001 SHAWNEE MISSION PKWY STE 130
Second Line	:
City	:	MISSION WOODS
State	:	KS
Zip	:	66205-2060
Country	:	US
Telephone Number	:	913-228-2000
Fax Number	:	855-354-0963

Provider Business Practice Location Address
First Line	:	2001 SHAWNEE MISSION PKWY STE 130
Second Line	:
City	:	MISSION WOODS
State	:	KS
Zip	:	66205-2060
Country	:	US
Telephone Number	:	913-228-2000
Fax Number	:	855-354-0963

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	04/01/2020

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Directions to “ SUE ANN DOUGLAS MD” Practice Location

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