Provider Demographics
NPI:1952527871
Name:DOUGLAS, BEN HAROLD II (MD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:HAROLD
Last Name:DOUGLAS
Suffix:II
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 1:1011 THIRD ST
Mailing Address - Street 2:BAY OCEAN MEDICAL, P.C.
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-8292
Mailing Address - Country:US
Mailing Address - Phone:503-842-7533
Mailing Address - Fax:503-842-9636
Practice Address - Street 1:1100 3RD ST
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-3402
Practice Address - Country:US
Practice Address - Phone:503-842-7533
Practice Address - Fax:503-842-9636
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19528207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1952527871Medicaid
E13971Medicare UPIN
R147088Medicare PIN
ORE13971Medicare UPIN