Provider Demographics
NPI:1821510629
Name:DONALD S. DOUGLAS, M.D.,
Entity Type:Organization
Organization Name:DONALD S. DOUGLAS, M.D.,
Other - Org Name:FOUKE FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-831-3033
Mailing Address - Street 1:3510 RICHMOND RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0712
Mailing Address - Country:US
Mailing Address - Phone:903-949-6961
Mailing Address - Fax:903-949-6965
Practice Address - Street 1:506 KENNETH JENKINS PARKWAY
Practice Address - Street 2:
Practice Address - City:FOUKE
Practice Address - State:AR
Practice Address - Zip Code:71837
Practice Address - Country:US
Practice Address - Phone:903-949-6961
Practice Address - Fax:903-949-6965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR137357001Medicaid