Provider Demographics
NPI:1558361725
Name:DOUGLAS, RONALD J (DPM)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E 3RD AVE
Mailing Address - Street 2:SUITE # 5
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1422
Mailing Address - Country:US
Mailing Address - Phone:509-838-2929
Mailing Address - Fax:509-838-2920
Practice Address - Street 1:225 E 3RD AVE
Practice Address - Street 2:SUITE # 5
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1422
Practice Address - Country:US
Practice Address - Phone:509-838-2929
Practice Address - Fax:509-838-2920
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA312213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1940204Medicaid
T02285Medicare UPIN
G000300395Medicare ID - Type Unspecified
WA0519590001Medicare NSC