Individual
KEVIN ANDREW DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
100 MIDDLE COUNTRY RD, CORAM, NY 11727-4412
(631) 696-9636
(631) 696-9635
Mailing address
1000 MONTAUK HWY, WEST ISLIP, NY 11795-4927
(631) 376-3420
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
N007168
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/11/2018
Last updated
06/06/2022
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