Individual
LAURIE EVANS DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
301 S 28TH AVE, HATTIESBURG, MS 39401-7233
(601) 261-1700
(601) 288-8290
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 261-1700
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
23948
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00324314
—
MS
01
—
10131735900
TRICARE
NC
05
—
10131735900
—
NC
01
—
187RG
BCBS
NC
01
—
Q94015
SC MEDICAID
NC
Enumeration date
08/04/2008
Last updated
07/09/2020
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