Provider Demographics
NPI:1902219132
Name:DOUGLAS, MATTHEW JOSEPH K (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOSEPH K
Last Name:DOUGLAS
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:UNIV AZ DEPT OF EMERGENCY MEDICINE
Mailing Address - Street 2:P.O. BOX 245057
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-5057
Mailing Address - Country:US
Mailing Address - Phone:520-626-7233
Mailing Address - Fax:520-626-1633
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:UNIVERSITY MEDICAL CENTER
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721
Practice Address - Country:US
Practice Address - Phone:520-626-7233
Practice Address - Fax:520-626-1633
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR74352207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine