Provider Demographics
NPI:1205905098
Name:STRONG, DOUGLAS FAY (MD)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:FAY
Last Name:STRONG
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 1:320 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2823
Mailing Address - Country:US
Mailing Address - Phone:989-723-8216
Mailing Address - Fax:989-729-0850
Practice Address - Street 1:320 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2823
Practice Address - Country:US
Practice Address - Phone:989-723-8216
Practice Address - Fax:989-729-0850
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDS042008207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2108120Medicaid
0100650OtherPHP
0807800041OtherBCBS
MI07800048083Medicare ID - Type Unspecified
0100650OtherPHP