Basic Information
| Provider Information | |||||||||
| NPI: | 1902329436 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DONALD DOUGLAS,MD | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BLUEGRASS INTERVENTIONAL THERAPIES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 733 CHINKAPIN DR STE 2 | ||||||||
| Address2: | |||||||||
| City: | NICHOLASVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403566023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592230721 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 261 RUCCIO WAY STE 190 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405033566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592660404 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2017 | ||||||||
| LastUpdateDate: | 07/17/2017 | ||||||||
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| AuthorizedOfficialLastName: | DOUGLAS | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8593125751 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP3300X | N | Ambulatory Health Care Facilities | Clinic/Center | Pain | 261QP3300X | 26259 | KY | Y | Ambulatory Health Care Facilities | Clinic/Center | Pain |
No ID Information.