Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | D78537 | MD |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | D78537 | MD |
NPI | 1184677817 |
---|---|
Provider Name | William Carlton Doukas |
First Address | Glen Burnie, MD 21061-6413 |
Second Address | Glen Burnie, MD 21061-6413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 23/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810011313 | (05) | WV |
4225051 | MEDICARE PTAN (01) | WV |