Provider Demographics
NPI:1811308257
Name:DOUGLAS, SAMUEL LESSLEY ARDIS (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:LESSLEY ARDIS
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 OFFICE PARK DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2457
Mailing Address - Country:US
Mailing Address - Phone:205-803-4384
Mailing Address - Fax:757-953-0845
Practice Address - Street 1:500 OFFICE PARK DR STE 400
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2457
Practice Address - Country:US
Practice Address - Phone:205-803-4384
Practice Address - Fax:757-953-0845
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL347272086X0206X, 208600000X
171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty