Individual
DR. RICHARD ALLEN DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.,F.A.C.S.
Contact information
Practice address
527 MEDICAL PARK DRIVE, SUITE 401, BRIDGEPORT, WV 26330
(681) 342-3500
(681) 342-3561
Mailing address
527 MEDICAL PARK DRIVE, SUITE 401, BRIDGEPORT, WV 26330
(681) 342-3500
(681) 342-3561
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
20050
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001709481
BC/BS
WV
05
—
0088893000
—
WV
Enumeration date
12/05/2005
Last updated
04/05/2022
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