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Individual

DAVID WAYMON DOUGLAS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1 TRILLIUM WAY, CORBIN, KY 40701-8426
(606) 528-1212
Mailing address
423 CEDAR RIDGE DR, LONDON, KY 40744-7446
(606) 878-9020

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
25732
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000074020
BLUE CROSS BLUE SHIELD
KY
05
64338304
KY
Enumeration date
06/05/2006
Last updated
11/30/2012
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