Provider Demographics
NPI:1659306611
Name:KANE, DOUGLAS W (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:W
Last Name:KANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N WASHINGTON AVE
Mailing Address - Street 2:STE 230
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2660
Mailing Address - Country:US
Mailing Address - Phone:931-520-8457
Mailing Address - Fax:931-520-6373
Practice Address - Street 1:315 N WASHINGTON AVE
Practice Address - Street 2:STE 230
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2660
Practice Address - Country:US
Practice Address - Phone:931-520-8457
Practice Address - Fax:931-520-6373
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18467207R00000X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4026322OtherBLUE CROSS PIN
7641262OtherCIGNA
010695688OtherTAX ID
020404400OtherUS DEPT OF LABOR
KY64049687Medicaid
010695688OtherTRICARE
204044OtherBLACK LUNG
TN3374966OtherMEDICARE GROUP PIN
TN3374966Medicaid
TN290015314OtherRAILROAD MEDICARE PIN
TN3858249Medicaid
204044OtherBLACK LUNG
TN3374966Medicaid