Individual
FREDERICK G DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
106 JOHN STREET, EASLEY, SC 29640-1415
(864) 859-2220
(864) 859-5744
Mailing address
PO BOX 2089, EASLEY, SC 29641-2089
(864) 855-5104
(864) 859-9362
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5691
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
056913
—
SC
05
—
134768
—
SC
01
—
582296052055
BLUE CROSS
SC
Enumeration date
06/12/2006
Last updated
02/10/2010
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