Provider Demographics
NPI:1366499675
Name:DOUGLAS, DONALD G (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:G
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 PLEASANT AVE S
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-1440
Mailing Address - Country:US
Mailing Address - Phone:218-732-2800
Mailing Address - Fax:218-732-2857
Practice Address - Street 1:705 PLEASANT AVE S
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1440
Practice Address - Country:US
Practice Address - Phone:218-732-2800
Practice Address - Fax:218-732-2857
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN246472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN12915OtherNDBS #
MN5154OtherSIOUX VALLEY #
MNHP25735OtherHEALTHPARTNERS #
MN126482OtherUCARE #
MN18686Medicaid
MN765067OtherAMERICA'S PPO/ARAZ #
MN8T818DOOtherMNBS #
MN13026OtherNDBS #
MNFS9041015681OtherPREFERRED ONE #
MN1600863OtherMEDICA #
MNMN200003OtherLHS/BANNERHEALTH #
MN12915OtherNDBS #