Individual
DR. JON C DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AUD
Contact information
Practice address
4202 E FOWLER AVE, TAMPA, FL 33620-8000
(813) 821-8038
(813) 974-0483
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
(813) 821-8038
(813) 974-0483
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
500-156
WI
231H00000X
Audiologist
Primary
AY2811
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123109900
—
FL
05
—
41153000
—
WI
01
—
60633
DEAN HEALTH INSURANCE
WI
01
—
E5VHB
BLUE CROSS BLUE SHIELD
FL
Enumeration date
02/09/2006
Last updated
08/20/2024
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