Provider Demographics
NPI:1902329436
Name:DONALD DOUGLAS,MD
Entity Type:Organization
Organization Name:DONALD DOUGLAS,MD
Other - Org Name:BLUEGRASS INTERVENTIONAL THERAPIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-312-5751
Mailing Address - Street 1:733 CHINKAPIN DR STE 2
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-6023
Mailing Address - Country:US
Mailing Address - Phone:859-223-0721
Mailing Address - Fax:
Practice Address - Street 1:261 RUCCIO WAY STE 190
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3566
Practice Address - Country:US
Practice Address - Phone:859-266-0404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26259261QP3300X
261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain