Individual
DR. LEONARD WALTER DOUGLAS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9237 UNIVERSITY BLVD, N CHARLESTON, SC 29406-9189
(843) 577-5011
(843) 863-0398
Mailing address
9237 UNIVERSITY BLVD, N CHARLESTON, SC 29406-9189
(843) 577-5011
(843) 863-0398
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11395
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113950
—
SC
01
—
AA50754950
MEDICARE PTAN
SC
Enumeration date
03/17/2006
Last updated
03/20/2013
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