Provider Demographics
NPI:1912185661
Name:REX, DOUGLAS AARON (DO,)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:AARON
Last Name:REX
Suffix:
Gender:M
Credentials:DO,
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:330 N WABASH
Mailing Address - Street 2:STE 320
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2600
Mailing Address - Country:US
Mailing Address - Phone:765-660-7600
Mailing Address - Fax:765-651-7313
Practice Address - Street 1:330 N WABASH AVE
Practice Address - Street 2:STE G370
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2678
Practice Address - Country:US
Practice Address - Phone:765-660-7500
Practice Address - Fax:765-662-3411
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003334B208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000611209OtherANTHEM
IN200916470Medicaid
INM400067986Medicare PIN
INM400067986Medicare PIN