Provider Demographics
NPI:1053416313
Name:DOUGLAS, DONALD R (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:R
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 CHINKAPIN DRIVE
Mailing Address - Street 2:STE 2
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356
Mailing Address - Country:US
Mailing Address - Phone:859-223-0721
Mailing Address - Fax:
Practice Address - Street 1:2537 LARKIN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3201
Practice Address - Country:US
Practice Address - Phone:270-554-5114
Practice Address - Fax:270-215-4834
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26259207LP2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
164291501OtherU. S. DOL
KY000000108104OtherANTHEM PIN
KY64262595Medicaid
KYF14766OtherBLUEGRASS FAMILY HEALTH
KY611369666OtherHUMANA PIN
KY2000319OtherUNITED HEALTHCARE
KY000000108104OtherANTHEM PIN
KYF14766OtherBLUEGRASS FAMILY HEALTH