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Individual

DR. BRAD H DOUGLAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
6900 TAVISTOCK LAKES BLVD STE 400, ORLANDO, FL 32827-7593
(954) 929-5624
(888) 368-2801
Mailing address
6900 TAVISTOCK LAKES BLVD STE 400, ORLANDO, FL 32827-7593
(954) 929-5624
(888) 368-2801

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
ME118938
FL
2083A0100X
Aerospace Medicine Physician
0101057909
VA
2083A0100X
Aerospace Medicine Physician
51110
NC
2083A0100X
Aerospace Medicine Physician
ME118938
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
-027
TRICARE/CHAMPUS
VA
01
10124384
OPTIMA HEALTH
VA
01
1588625909
VIRGINIA PREMIER HEALTH PLAN
VA
05
1588625909
NC
05
1588625909
VA
01
507769
ANTHEM BC/BS
VA
01
PAR
AETNA
VA
Enumeration date
03/28/2006
Last updated
01/10/2026
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