Provider Demographics
NPI:1598739013
Name:DOUGLASS, ALEXANDER B (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:B
Last Name:DOUGLASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-2805
Mailing Address - Country:US
Mailing Address - Phone:903-872-6230
Mailing Address - Fax:903-654-4625
Practice Address - Street 1:1505 N 22ND ST
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2805
Practice Address - Country:US
Practice Address - Phone:903-872-6230
Practice Address - Fax:903-654-4625
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0981208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752616977073OtherTRICARE CHAMPUS
TXDO08S3130OtherBCBS
TX134639OtherCHIPS
TXP00238470OtherMEDICARE RAILROAD
TXP00238470OtherMEDICARE RAILROAD
TX8D6443Medicare ID - Type Unspecified