Douglass Eugene Martin, ED.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY000307 Issued in MO

Practice address

4013 NE 57TH PL
Gladstone, MO 64119-2268

Phone

(816) 536-1828

Fax

(816) 413-5305

NPI assigned

Nov 1, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263945600000",
    "number": "1649357211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4013 NE 57TH PL",
            "city": "GLADSTONE",
            "state": "MO",
            "postal_code": "641192268",
            "telephone_number": "816-536-1828",
            "fax_number": "816-413-5305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4013 NE 57TH PL",
            "city": "GLADSTONE",
            "state": "MO",
            "postal_code": "641192268",
            "telephone_number": "816-536-1828",
            "fax_number": "816-413-5305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "DOUGLASS",
        "middle_name": "EUGENE",
        "name_prefix": "Dr.",
        "credential": "ED.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2010-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MO",
            "license": "PY000307",
            "primary": true
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "MO",
            "license": "PY000307",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROVIDER #",
            "identifier": "16469011",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cassandra Renee Malcolm, PLPC
• Aysha Malik, PHARMD
• Andrew Mancin
• Dixie Sue Manroe, FNP BC
• Shelby Markum, LSCSW, LCSW
• Emily Kay Marx, D.D.S.
• April J Matusiak
• MC Medical LLC (Walmart Health)
• Kathryn R McCampbell, OD
• Chris M McClenney, DC

• Psychologist in Gladstone, MO
• Providers in Gladstone, MO by specialty
• Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2010; 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.