Individual provider Active NPI

Douglas R Douville, MD

  • Family Medicine Physician
  • West Valley City, UT
National Provider Identifier
1497786677
Registry record updated Mar 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2738881205 Issued in UT
Practice address
3725 W 4100 South
West Valley City, UT 84120
Phone
(801) 965-3600
Fax
(801) 965-3526
NPI assigned
Jul 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2738881205 UT Primary

Addresses

Primary practice location

3725 W 4100 South
West Valley City, UT 84120

Mailing address

3725 W 4100 South
West Valley City, UT 84120
Phone (801) 965-3600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2738881205UTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Granger Medical Specialists LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: douglas.douville.1@13794.direct.athenahealth.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237334400000",
    "number": "1497786677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3725 W 4100 SOUTH",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "84120",
            "telephone_number": "801-965-3600",
            "fax_number": "801-965-3526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3725 W 4100 SOUTH",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "84120",
            "telephone_number": "801-965-3600",
            "fax_number": "801-965-3526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUVILLE",
        "first_name": "DOUGLAS",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2009-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "2738881205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Valley City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2009; 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.