Mark Stephen Douglas, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

0101242719 Issued in VA

Practice address

2080 Child St
Department of Dermatology - Naval Hospital Jacksonville
Jacksonville, FL 32214-5005

Phone

(904) 542-7912

Fax

(904) 542-7917

NPI assigned

Dec 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, VA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740441600000",
    "number": "1649335118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 S QUAIL CIR",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928074428",
            "telephone_number": "904-542-7912",
            "fax_number": "904-542-7917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 CHILD ST",
            "address_2": "DEPARTMENT OF DERMATOLOGY - NAVAL HOSPITAL JACKSONVILLE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322145005",
            "telephone_number": "904-542-7912",
            "fax_number": "904-542-7917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "MARK",
        "middle_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-26",
        "last_updated": "2025-02-25",
        "certification_date": "2025-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "VA",
            "license": "0101242719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Breanna Douglas
• Hannah Douglas, APRN
• Hannah D Douglas
• Katherine Douglas, RD/RDN
• Kianna Douglas, RBT
• Moriah Nicole Douglas
• Theron Douglas, PHARMD
• William Douglas
• Amanda S Douglass, DPT
• Doulas Divine Community Services LLC

• Dermatology Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.