MEDICARE: MARK JASON DOUGLAS M.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	00020396	AL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51506459	OTHER	AL	BLUE CROSS AL PROV #
2	7070250	OTHER	AL	AETNA PROVIDER #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	51506758	OTHER	AL	BLUE CROSS AL PROV #
5	H07553	OTHER	AL	HEALTHSPRING PROVIDER #
6	51502488	OTHER	AL	BLUE CROSS OF AL PROV #
7	51531041	OTHER	AL	BLUE CROSS AL PROV #
8	51536524	OTHER	AL	BLUE CROSS AL PROV #
9	0810439	OTHER	AL	UNITED HEALTHCARE PROV #
10	51505297	OTHER	AL	BLUE CROSS OF AL PROV #
11	51506756	OTHER	AL	BLUE CROSS AL PROV #

NPI Number	:	1679576516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK JASON DOUGLAS M.D.

Provider Business Mailing Address
First Line	:	2880 DAUPHIN ST
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36606-2457
Country	:	US
Telephone Number	:	251-473-1900
Fax Number	:	251-470-8943

Provider Business Practice Location Address
First Line	:	2880 DAUPHIN ST
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36606-2457
Country	:	US
Telephone Number	:	251-473-1900
Fax Number	:	251-470-8943

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	11/19/2007

67 WALNUT AVE
CLARK, NJ
07066-1640

Practice Phone: 732-388-7300
Practice Fax: 732-388-1330