Provider Demographics
NPI:1396713087
Name:DOUGLASS, WILLIAM CAMPBELL III (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CAMPBELL
Last Name:DOUGLASS
Suffix:III
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 1:400 CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8172
Mailing Address - Country:US
Mailing Address - Phone:386-231-4430
Mailing Address - Fax:
Practice Address - Street 1:400 CLYDE MORRIS BLVD STE A
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8172
Practice Address - Country:US
Practice Address - Phone:386-231-4430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56428207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11314OtherBCBS
FL063935400Medicaid
FL11314DMedicare ID - Type Unspecified