Provider Demographics
NPI:1649553165
Name:SEGARS, DOUGLAS (DO)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:SEGARS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 HULEN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-7277
Mailing Address - Country:US
Mailing Address - Phone:817-569-4300
Mailing Address - Fax:
Practice Address - Street 1:2400 NW 24TH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76106-6629
Practice Address - Country:US
Practice Address - Phone:817-569-5000
Practice Address - Fax:817-569-5048
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXP23612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DK393OtherBCBS
TX305792901Medicaid
TX305792902OtherMEDICAID CSHCN
TX305792901Medicaid