# GEORGE M DOUGLASS MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386983922
- **Authorized official:** GEORGE M DOUGLASS JR. MD (OWNER)
- **Authorized official phone:** (503) 502-3989

## Contact information

- **Practice address:** 9445 SW LOCUST ST, TIGARD, OR 97223-6634
- **Practice address phone:** (503) 352-1313
- **Practice address fax:** (503) 352-1314
- **Mailing address:** 9445 SW LOCUST ST, TIGARD, OR 97223-6634
- **Mailing address phone:** (503) 352-1313
- **Mailing address fax:** (503) 352-1314

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207PS0010X | Sports Medicine (Emergency Medicine) Physician | MD22100 | OR | Yes |

## Other

- **Enumeration date:** 02/01/2013
- **Last updated:** 02/01/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 240052 | — | OR |