Provider Demographics
NPI:1245294719
Name:BRIGHT, DOUGLAS ALAN (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ALAN
Last Name:BRIGHT
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 1:353 FAIRMONT BLVD
Mailing Address - Street 2:ATTEN MEDICAL STAFF SERVICES
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6000
Mailing Address - Country:US
Mailing Address - Phone:605-719-7109
Mailing Address - Fax:605-719-1027
Practice Address - Street 1:502 E. MONROE STREET
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-719-4060
Practice Address - Fax:605-719-4012
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3650207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0000054OtherWESTERN HEALTH
SD0003942OtherBLUE CROSS BLUE SHIELD
SD5608390Medicaid
SD5608390Medicaid
SD0003942OtherBLUE CROSS BLUE SHIELD