Basic Information
| Provider Information | |||||||||
| NPI: | 1396369088 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DOUG S CLOUSE MD PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64568 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850824568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803747352 | ||||||||
| FaxNumber: | 4805850051 | ||||||||
| Practice Location | |||||||||
| Address1: | 20715 E OCOTILLO RD STE 102 | ||||||||
| Address2: | |||||||||
| City: | QUEEN CREEK | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 851426118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808994333 | ||||||||
| FaxNumber: | 4808997219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2020 | ||||||||
| LastUpdateDate: | 05/29/2020 | ||||||||
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| AuthorizedOfficialLastName: | CLOUSE | ||||||||
| AuthorizedOfficialFirstName: | DOUGLAS | ||||||||
| AuthorizedOfficialMiddleName: | STEVEN | ||||||||
| AuthorizedOfficialTitleorPosition: | MD/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4808994333 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 05/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.