Provider Demographics
NPI:1497750731
Name:DOUGLAS, SUE ANN (MD)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ANN
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 SHAWNEE MISSION PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:MISSION WOODS
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2060
Mailing Address - Country:US
Mailing Address - Phone:913-228-2000
Mailing Address - Fax:855-354-0963
Practice Address - Street 1:2001 SHAWNEE MISSION PKWY STE 130
Practice Address - Street 2:
Practice Address - City:MISSION WOODS
Practice Address - State:KS
Practice Address - Zip Code:66205-2060
Practice Address - Country:US
Practice Address - Phone:913-228-2000
Practice Address - Fax:855-354-0963
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7958207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194491002Medicaid
TXTXB132972Medicare PIN
TX8K0970Medicare PIN
TX8K0973Medicare PIN