Individual
DR. DOUGLASS EUGENE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.D.
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY000307
MO
103TA0400X
Addiction (Substance Use Disorder) Psychologist
PY000307
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16469011
BC/BS PROVIDER #
MO
Enumeration date
11/01/2006
Last updated
01/20/2010
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