Provider Demographics
NPI:1164414710
Name:TOWRISS, DOUGLAS A (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:A
Last Name:TOWRISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SAINT LOUIS AVE
Mailing Address - Street 2:PO BOX 427
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-0427
Mailing Address - Country:US
Mailing Address - Phone:812-522-4084
Mailing Address - Fax:812-523-2013
Practice Address - Street 1:120 SAINT LOUIS AVE
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2304
Practice Address - Country:US
Practice Address - Phone:812-522-4084
Practice Address - Fax:812-523-2013
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01051179A207R00000X, 208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INH74624Medicare UPIN
IN194300AMedicare ID - Type Unspecified