Provider Demographics
NPI:1336114388
Name:VERMILLION, DOUG A (MD)
Entity Type:Individual
Prefix:
First Name:DOUG
Middle Name:A
Last Name:VERMILLION
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 1:2741 DEBARR RD STE C214
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2978
Mailing Address - Country:US
Mailing Address - Phone:907-644-6055
Mailing Address - Fax:907-644-4885
Practice Address - Street 1:2741 DEBARR RD STE C214
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2978
Practice Address - Country:US
Practice Address - Phone:907-644-6055
Practice Address - Fax:907-644-4885
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4783207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G56037Medicare UPIN
TX8385K5Medicare ID - Type Unspecified