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NPI Code Detail

MEDICARE: DONALD DOUGLAS,MD

MEDICARE: DONALD 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
1261QP3300XPain Clinic/Center
2261QP3300XPain Clinic/Center26259KY

General Provider Information

NPI Number : 1902329436
Entity Type Code : Organization
Provider Name (Legal Business Name) : DONALD DOUGLAS,MD
Provider Business Mailing Address
First Line : 733 CHINKAPIN DR STE 2
Second Line :
City : NICHOLASVILLE
State : KY
Zip : 40356-6023
Country : US
Telephone Number : 859-223-0721
Fax Number :
Provider Business Practice Location Address
First Line : 261 RUCCIO WAY STE 190
Second Line :
City : LEXINGTON
State : KY
Zip : 40503-3566
Country : US
Telephone Number : 859-266-0404
Fax Number :
Authorized Official
Title or Position : PHYSICIAN
Name : DR. DONALD R. DOUGLAS
Credential : MD
Telephone Number : 859-312-5751
Provider Enumeration Date : 07/17/2017
Last Update Date : 07/17/2017

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