Provider Demographics
NPI:1336182914
Name:DOUGLASS, GEORGE M JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:M
Last Name:DOUGLASS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:17355 BOONES FERRY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-5202
Mailing Address - Country:US
Mailing Address - Phone:503-344-6445
Mailing Address - Fax:503-344-6852
Practice Address - Street 1:17355 BOONES FERRY RD
Practice Address - Street 2:SUITE C
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5202
Practice Address - Country:US
Practice Address - Phone:503-344-6445
Practice Address - Fax:503-344-6852
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD22100207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR240052Medicaid
8942008OtherWA CRIME VICTIMS
P00350187OtherRAILROAD MEDICARE
210868OtherWA L & I
WA8244444Medicaid
OR240052Medicaid