Individual
GARY DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
198135
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010047904
UNIVERA
NY
01
—
000523560007
BC/BS
NY
05
—
01545188
—
NY
01
—
040426002829
FIDELIS
NY
01
—
148117FL
PREFERRED CARE
NY
01
—
1709798
IHA
NY
Enumeration date
10/06/2005
Last updated
07/13/2026
Update your record
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