Individual
MR. JOHN WILLIAM DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15190 COMMUNITY RD, SUITE 220, GULFPORT, MS 39503-3485
(228) 539-3356
(228) 539-3225
Mailing address
PO BOX 1810, GULFPORT, MS 39502
(228) 575-1194
(228) 575-2917
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
08130
MS
207RP1001X
Pulmonary Disease Physician
8130
MS
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
8130
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00019714
—
MS
01
—
08130
STATE LICENSE
MS
Enumeration date
06/28/2006
Last updated
04/10/2023
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