Provider Demographics
NPI:1902804800
Name:DOUKAS, DAVID JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:DOUKAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 E BROADWAY
Mailing Address - Street 2:SUITE 290
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1785
Mailing Address - Country:US
Mailing Address - Phone:502-217-8221
Mailing Address - Fax:502-217-5056
Practice Address - Street 1:215 CENTRAL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-1418
Practice Address - Country:US
Practice Address - Phone:502-852-2822
Practice Address - Fax:502-852-2819
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY23324207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64090152Medicaid
IN200489450Medicaid
KY0523937Medicare PIN
IN200489450Medicaid
KY0048447Medicare PIN
KY0631243Medicare PIN
KY0601239Medicare PIN
KY0921013Medicare PIN
KY64090152Medicaid