Individual
DR. BRUCE G DOUGLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
934 S GARFIELD AVE STE C, TRAVERSE CITY, MI 49686-2402
(231) 946-4419
Mailing address
934 S GARFIELD AVE STE C, TRAVERSE CITY, MI 49686-2402
(231) 946-4419
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
003193
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
383446966
TAX ID
MI
01
—
680B813220
BCBS
MI
Enumeration date
09/27/2006
Last updated
03/28/2009
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