Provider Demographics
NPI:1649278037
Name:JENNINGS, DOUGLAS L (DO)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:L
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 SYLVAN WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-2851
Mailing Address - Country:US
Mailing Address - Phone:360-479-3657
Mailing Address - Fax:360-373-7616
Practice Address - Street 1:990 SYLVAN WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2851
Practice Address - Country:US
Practice Address - Phone:360-479-3657
Practice Address - Fax:360-373-7616
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001360207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA016487001OtherGROUP HEALTH CORP
WA79703OtherLABOR AND INDUSTRIES
WA8934065OtherVICTIMS OF CRIME
WA910847215OtherUNIFORM MEDICAL
WA910847215OtherPREMERA BLUE CROSS
WA91084721523OtherKPS
WA050020529OtherRAILROAD MEDICARE
WAJE7215OtherREGENCE BLUE SHIELD
WA8137572Medicaid
WA91084721523OtherKPS
WA000201020Medicare ID - Type UnspecifiedMEDICARE