Provider Demographics
NPI:1881699932
Name:DOUGLIS, FRANKLIN M (MD)
Entity type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:M
Last Name:DOUGLIS
Suffix:
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 1:3000 W DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2036
Mailing Address - Country:US
Mailing Address - Phone:936-539-9322
Mailing Address - Fax:936-539-9104
Practice Address - Street 1:3000 W DAVIS ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2072
Practice Address - Country:US
Practice Address - Phone:936-539-9322
Practice Address - Fax:936-539-9104
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2024-07-01
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
TXG2687174400000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112784704Medicaid
TX112784706Medicaid
TX112784704Medicaid
TX8793B0Medicare PIN
TX112784706Medicaid