Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Individual
DR. JERRY EDWARD DOUGLAS
Active
Individual
DR. JERRY EDWARD DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01032101A
IN
207Q00000X
Family Medicine Physician
Primary
53653
CA
207Q00000X
Family Medicine Physician
C53653
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000190581
ANTHEM PROVIDER NUMBER
IN
01
—
11484440
CAQH NUMBER
IN
01
—
162528
PHCS PID NUMBER
IN
05
—
200100490
—
IN
Enumeration date
03/17/2006
Last updated
04/02/2018
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign upProduct
Developers