Provider Demographics
NPI:1669495990
Name:DOUGLASS, THOMAS SCOTT III (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:SCOTT
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 1:28827 DIAMONDHEAD SO
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-2814
Mailing Address - Country:US
Mailing Address - Phone:218-780-3117
Mailing Address - Fax:
Practice Address - Street 1:28827 DIAMONDHEAD SO
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-2814
Practice Address - Country:US
Practice Address - Phone:218-780-3117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN222942083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN969327100Medicaid