Provider Demographics
NPI:1023052669
Name:MAPOSA, DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:MAPOSA
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:DEPT 2130
Mailing Address - Street 2:PO BOX 11407
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-2130
Mailing Address - Country:US
Mailing Address - Phone:601-925-6805
Mailing Address - Fax:
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-6426
Practice Address - Fax:601-984-6439
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXFTL 41682207L00000X
TXFTL 42151207L00000X
TXFTL 42574207L00000X
MS22415207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01029083Medicaid
TX159967201Medicaid
TX8G8347OtherBCBS
AL156827Medicaid
TX159967202OtherCSHCN
MS01029083Medicaid
TX159967201Medicaid
TXH91783Medicare UPIN
MS293000YR8UMedicare PIN