Provider Demographics
NPI:1386645166
Name:RANKIN, DOUGLAS HALL (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:HALL
Last Name:RANKIN
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 1:6800 W GATE BLVD
Mailing Address - Street 2:#132-326
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-9997
Mailing Address - Country:US
Mailing Address - Phone:512-707-8874
Mailing Address - Fax:
Practice Address - Street 1:6800 W GATE BLVD
Practice Address - Street 2:#132-326
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-9997
Practice Address - Country:US
Practice Address - Phone:512-707-8874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2867207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099708201Medicaid
C20857Medicare UPIN
TX099708201Medicaid