Provider Demographics
NPI:1326299843
Name:HAMBLIN, DOUGLAS SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:SCOTT
Last Name:HAMBLIN
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 1:605 WELCH ST
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1946
Mailing Address - Country:US
Mailing Address - Phone:503-782-1975
Mailing Address - Fax:503-343-6232
Practice Address - Street 1:605 WELCH ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1946
Practice Address - Country:US
Practice Address - Phone:503-782-1975
Practice Address - Fax:503-343-6232
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104220208M00000X
ORMD167314208000000X
FLME104220208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBY092ZOtherMEDICARE PTAN
FL001217400Medicaid
OR500675213Medicaid