Provider Demographics
NPI:1588625909
Name:DOUGLAS, BRAD H (MD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:H
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1801 LEE RD STE 165
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2127
Mailing Address - Country:US
Mailing Address - Phone:407-975-0406
Mailing Address - Fax:407-975-0407
Practice Address - Street 1:601 E ROLLINS ST
Practice Address - Street 2:FLORIDA HOSPITAL OB SPECIALISTS
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1248
Practice Address - Country:US
Practice Address - Phone:407-975-0406
Practice Address - Fax:407-975-0407
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057909207V00000X, 2083A0100X
FLME118938207V00000X
TN51110207V00000X
NC2014-00156207V00000X
SCMD36587207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1588625909OtherVIRGINIA PREMIER HEALTH PLAN
VAPAROtherAETNA
VA1588625909Medicaid
VA-027OtherTRICARE/CHAMPUS
VA10124384OtherOPTIMA HEALTH
VA1588625909OtherUNITED HEALTHCARE
NC1588625909Medicaid
VAPAROtherMULTIPLAN
VA1588625909OtherCOVENTRY NETWORK
VAPAROtherUSA MANAGED CARE
VAPAROtherVIRGINIA HEALTH NETWORK
VA507769OtherANTHEM BC/BS
VAPAROtherCIGNA
VA1588625909OtherCOVENTRY NETWORK