Provider Demographics
NPI:1275581720
Name:APPLEBY, DOUGLAS CLAUDE JR (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:CLAUDE
Last Name:APPLEBY
Suffix:JR
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 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:329 COATSLAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3912
Practice Address - Country:US
Practice Address - Phone:731-424-5080
Practice Address - Fax:731-424-4109
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23457208G00000X
SC14891208G00000X
TN51126208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ004585Medicaid
SCTL2704Medicaid
SC5712035OtherAETNA
SC330005732OtherRR MEDICARE
SCTL2704Medicaid
SCC725627951Medicare PIN
SC5154300OtherCIGNA
SC57-6007863101OtherBLUE CHOICE OF SC
SCC72562Medicare UPIN