Individual
MR. RONALD JASON DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5001 US HIGHWAY 30 W STE D, FORT WAYNE, IN 46818-9701
(260) 432-1568
(260) 432-4969
Mailing address
PO BOX 80070, FORT WAYNE, IN 46898-0070
(260) 432-1568
(260) 432-4969
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000680A
IN
Other
Enumeration date
01/27/2006
Last updated
11/17/2014
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