Provider Demographics
NPI:1568423770
Name:STEELE, DOUGLAS ALLEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:ALLEN
Last Name:STEELE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJP BONE & JOINT INSTITUTE @ SHANDS
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-5942
Practice Address - Fax:904-244-3457
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101737363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2911493-00Medicaid
GA887190539BMedicaid
FL015492100Medicaid
FLU6021ZMedicare PIN
FL2911493-00Medicaid
FLP41437Medicare UPIN
FL970021911Medicare PIN