Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 3650 | SD |
NPI | 1245294719 |
---|---|
Provider Name | Douglas Alan Bright |
First Address | Rapid City, SD 57701-6000 |
Second Address | Rapid City, SD 57701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 04/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000054 | WESTERN HEALTH (01) | SD |
0003942 | BLUE CROSS BLUE SHIELD (01) | SD |
5608390 | (05) | SD |
A73166 | (02) |