Provider Demographics
NPI:1437773520
Name:RAYMOND DOUGLAS, M.D., PHD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RAYMOND DOUGLAS, M.D., PHD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-657-4302
Mailing Address - Street 1:9675 BRIGHTON WAY STE 410
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5192
Mailing Address - Country:US
Mailing Address - Phone:310-363-8757
Mailing Address - Fax:310-363-8758
Practice Address - Street 1:9675 BRIGHTON WAY STE 410
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5192
Practice Address - Country:US
Practice Address - Phone:310-363-8757
Practice Address - Fax:310-363-8758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty