Provider Demographics
NPI:1538901830
Name:RAYMOND DOUGLAS, M.D., PHD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:RAYMOND DOUGLAS, M.D., PHD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-363-8757
Mailing Address - Street 1:653 N TOWN CENTER DR STE 512
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0519
Mailing Address - Country:US
Mailing Address - Phone:310-636-8757
Mailing Address - Fax:310-363-8758
Practice Address - Street 1:653 N TOWN CENTER DR STE 512
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0519
Practice Address - Country:US
Practice Address - Phone:310-636-8757
Practice Address - Fax:310-636-8758
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAYMOND DOUGLAS, M.D., PHD A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty