Provider Demographics
NPI:1124189667
Name:MARION A. DOUGLASS III, MD
Entity Type:Organization
Organization Name:MARION A. DOUGLASS III, MD
Other - Org Name:RBHA NETWORK
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:DOUGLASS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:520-570-1479
Mailing Address - Street 1:620 N CRAYCROFT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1448
Mailing Address - Country:US
Mailing Address - Phone:520-748-7108
Mailing Address - Fax:520-748-1458
Practice Address - Street 1:620 N CRAYCROFT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1448
Practice Address - Country:US
Practice Address - Phone:520-748-7108
Practice Address - Fax:520-748-1458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32713251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health