Provider Demographics
NPI:1356922603
Name:DOUGLAS, JASMINE DOMINIQUE (MD)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:DOMINIQUE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S RAGSDALE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-2434
Mailing Address - Country:US
Mailing Address - Phone:903-541-5396
Mailing Address - Fax:903-541-5393
Practice Address - Street 1:501 S RAGSDALE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-2434
Practice Address - Country:US
Practice Address - Phone:903-541-5396
Practice Address - Fax:903-541-5393
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU0996207Q00000X
ARE-18050207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine