Provider Demographics
NPI:1538735766
Name:DOUGLAS, ORLANDO D
Entity type:Individual
Prefix:
First Name:ORLANDO
Middle Name:D
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 E 71ST ST STE C
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5572
Mailing Address - Country:US
Mailing Address - Phone:918-794-6570
Mailing Address - Fax:918-340-5189
Practice Address - Street 1:2508 E 71ST ST STE C
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5572
Practice Address - Country:US
Practice Address - Phone:918-794-6570
Practice Address - Fax:918-340-5189
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty