Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 082665 | NY |
N | 208D00000X | General Practice Physician | 082665 | NY |
NPI | 1316286404 |
---|---|
Provider Name | Dr. Harold O Douglass JR. |
First Address | Williamsville, NY 14221-3309 |
Second Address | Williamsville, NY 14221-3309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2013 |
Last Update Date | 08/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E97195 | (02) | NY |