Individual
GARY DOUGLAS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1026 UNION RD, WEST SENECA, NY 14224-3449
(716) 712-0858
(716) 712-0859
Mailing address
1026 UNION RD, WEST SENECA, NY 14224-3449
(716) 712-0858
(716) 712-0859
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
07/08/2007
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