George M Douglass MD PC

Primary specialty

Sports Medicine (Emergency Medicine) PhysicianTaxonomy code 207PS0010X

License

MD22100 Issued in OR

Legal business name

GEORGE M DOUGLASS MD PC

Practice address

9445 SW Locust St
Tigard, OR 97223-6634

Phone

(503) 352-1313

Fax

(503) 352-1314

NPI assigned

Feb 1, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

George M Douglass Jr., MD

Title

Owner

Phone

(503) 502-3989

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1359676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359676800000",
    "number": "1386983922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9445 SW LOCUST ST",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972236634",
            "telephone_number": "503-352-1313",
            "fax_number": "503-352-1314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9445 SW LOCUST ST",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972236634",
            "telephone_number": "503-352-1313",
            "fax_number": "503-352-1314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGE M DOUGLASS MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-01",
        "last_updated": "2013-02-01",
        "status": "A",
        "authorized_official_last_name": "DOUGLASS",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-502-3989",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207PS0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "OR",
            "license": "MD22100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "240052",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Sports Medicine (Emergency Medicine) Physician in Tigard, OR
• Providers in Tigard, OR by specialty
• Sports Medicine (Emergency Medicine) Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.