Provider Demographics
NPI:1134441082
Name:POSS, DOUGLAS EDWARD (MA, BS)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:EDWARD
Last Name:POSS
Suffix:
Gender:M
Credentials:MA, BS
Other - Prefix:
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Mailing Address - Street 1:5208 LAKEWOOD TER
Mailing Address - Street 2:101
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-4046
Mailing Address - Country:US
Mailing Address - Phone:314-438-5831
Mailing Address - Fax:
Practice Address - Street 1:5208 LAKEWOOD TER
Practice Address - Street 2:101
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-4046
Practice Address - Country:US
Practice Address - Phone:314-438-5831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO1111487291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1111487OtherMISSOURI MEDICAL TECHNOLOGIST II