Provider Demographics
NPI:1639724321
Name:DOUGLAS, WILLIAM CONRAD
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CONRAD
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1446
Mailing Address - Country:US
Mailing Address - Phone:740-533-9850
Mailing Address - Fax:
Practice Address - Street 1:611 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1446
Practice Address - Country:US
Practice Address - Phone:740-533-9850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator