Individual
SAMUEL DOUGLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1055 N CURTIS RD, BOISE, ID 83706-1309
(208) 367-2121
(706) 596-6720
Mailing address
877 W MAIN ST STE 603, BOISE, ID 83702-6070
(208) 954-8070
(208) 954-8073
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
1539
NE
2085R0202X
Diagnostic Radiology Physician
DO219310
OR
2085R0202X
Diagnostic Radiology Physician
Primary
OC-0433
ID
2085R0202X
Diagnostic Radiology Physician
OP61322937
WA
Other
Enumeration date
01/20/2015
Last updated
04/18/2025
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