Provider Demographics
NPI:1760467187
Name:DOUGLAS, JAMES W (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901
Mailing Address - Country:US
Mailing Address - Phone:207-877-7100
Mailing Address - Fax:
Practice Address - Street 1:10 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4315
Practice Address - Country:US
Practice Address - Phone:207-877-7100
Practice Address - Fax:207-872-6134
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME323710099Medicaid
1041834OtherAETNA
080166322OtherRAILROAD
ME323710099Medicaid
1041834OtherAETNA