Provider Demographics
NPI:1144334509
Name:DOUGLAS, DONALD STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:STEVEN
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-0310
Mailing Address - Country:US
Mailing Address - Phone:870-425-5233
Mailing Address - Fax:870-424-8455
Practice Address - Street 1:624 HOSPITAL DR
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2955
Practice Address - Country:US
Practice Address - Phone:870-425-5233
Practice Address - Fax:870-424-8455
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4442174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR220023532OtherRAILROAD MEDICARE
AR161027001Medicaid