Provider Demographics
NPI:1376577304
Name:SAWYER, DOUGLAS CLAYTON (MD)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:CLAYTON
Last Name:SAWYER
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 1:130 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-2602
Mailing Address - Country:US
Mailing Address - Phone:318-872-2700
Mailing Address - Fax:318-872-6214
Practice Address - Street 1:119 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052
Practice Address - Country:US
Practice Address - Phone:318-872-5810
Practice Address - Fax:318-872-2763
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025688208600000X
LAMD.025688208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1041696Medicaid
I07633Medicare UPIN
LA4F983Medicare PIN