Basic Information
| Provider Information | |||||||||
| NPI: | 1528263498 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOUGLAS | ||||||||
| FirstName: | OXANA | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7717 COLLIER BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341142768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396248220 | ||||||||
| FaxNumber: | 2396248221 | ||||||||
| Practice Location | |||||||||
| Address1: | 7717 COLLIER BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341142768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396248220 | ||||||||
| FaxNumber: | 2396248221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2007 | ||||||||
| LastUpdateDate: | 11/07/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 42939 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME119711 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | HZ163Y | 01 | FL | MEDICARE | OTHER | 013496000 | 05 | FL | MEDICAID | 14X36 | 01 | FL | BCBS | OTHER |