Jack Douglas

NPI 1508054404 · on the registry since 2007 · sole proprietor

Practice

Address: 1065 E Broad St
Monticello, MS 39654
Phone: (601) 587-7115
Organisation at this address: Atwood Emergency Physicians Llc
Mississippi Em-I Medical Serives Pc
Southwest Ms Regional Medical Center
Southwest Mississippi Regional Medical Center
Southwest Mississippi Regional Medical Center
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 8

Registry record

Primary taxonomy: 225100000X
225100000X
Licence states on file: MS
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2010-04-07

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Mississippi