Provider Demographics
NPI:1285654285
Name:DOUGLAS, WILLIAM LADELL (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LADELL
Last Name:DOUGLAS
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 1:100 E 20TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801-8213
Mailing Address - Country:US
Mailing Address - Phone:870-777-2100
Mailing Address - Fax:870-777-4851
Practice Address - Street 1:100 E 20TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-8213
Practice Address - Country:US
Practice Address - Phone:870-777-2100
Practice Address - Fax:870-777-4851
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR45352080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR144850000OtherQUAL CHOICE
AR124721001Medicaid
AR5J306OtherBCBS
AR144850000OtherQUAL CHOICE