Basic Information
| Provider Information | |||||||||
| NPI: | 1023052669 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAPOSA | ||||||||
| FirstName: | DOUGLAS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 2130 | ||||||||
| Address2: | PO BOX 11407 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352462130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019256805 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2500 N STATE ST | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392164500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019846426 | ||||||||
| FaxNumber: | 6019846439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 04/04/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | FTL 41682 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | FTL 42151 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | FTL 42574 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 22415 | MS | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 01029083 | 05 | MS | MEDICAID | 159967201 | 05 | TX | MEDICAID | 8G8347 | 01 | TX | BCBS | OTHER | 156827 | 05 | AL | MEDICAID | 159967202 | 01 | TX | CSHCN | OTHER |