DR. DEREK DOUGLAS (NPI# 1154747657) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154747657 |
| Entity Type | Individual |
| Full Name | DR. DEREK DOUGLAS |
| Credential | M.D |
| Practice Address |
650 Joel Dr Fort Campbell KY 42223-5318 |
| Mailing Address |
5005 N Piedras St El Paso TX 79920 |
| Practice Telephone | 2707988727 |
| Enumeration Date | 2014-03-10 |
| Last Update Date | 2020-07-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | 35.128034 | OH | Allopathic & Osteopathic Physicians |
| N | 208D00000X | General Practice | 128034 | OH | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 9040 Fitzsimmons Dr, Joint Base Lewis Mcchord, WA 984311000 | 2539682997 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740759349 | Derek Anthony Douglas | Occupational Therapist | 13950 Brandywine Rd, Brandywine, MD 20613-5815 | 2018-11-13 |
| 1902307762 | Derek Bradley Douglas | General Practice | 9040 Fitzsimmons Dr, Joint Base Lewis Mcchord, WA 98431-1000 | 2018-02-26 |
| Street Address |
650 JOEL DR |
| City | FORT CAMPBELL |
| State | KY |
| Zip Code | 42223-5318 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982601803 | Carol Lynn Pasewark | Counselor | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2005-07-07 |
| 1568063519 | Jeremy Schadewald | Physician Assistant | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2020-11-05 |
| 1578164760 | Brandi Mangan | Nurse Practitioner | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2020-11-04 |
| 1912506692 | Rose Dunn | Optometrist | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2020-10-22 |
| 1659989440 | Patrick Ogden | Student in an Organized Health Care Education/Training Program | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2020-07-17 |
| 1487262408 | John William Zamora | Physician Assistant | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2020-07-15 |
| 1295343218 | Joshua Ryan Agard | Physician Assistant | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2020-07-15 |
| 1902424435 | Shaina Escribano-miranda | Nurse Practitioner | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2020-07-10 |
| 1326665514 | Cristal Lagail Trotter | Nurse Anesthetist, Certified Registered | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2020-07-03 |
| 1689209728 | William James Bradshaw | Physician Assistant | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2020-03-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558978825 | Eden Addisu Kebede | Social Worker | Ft. Campbell/bach, 650 Joel Drive, Fort Campbell, KY 42223 | 2020-09-30 |
| 1174134662 | Lucas Pepper | Dentist | Desert Storm Ave, Bldg 5580, Apo, AA 42223 | 2020-08-10 |
| 1639711203 | Travis Robert Bryant | Optometrist | 5979 Desert Storm Ave., Lapointe Health Clnic Optometry, Ft. Campbell, KY 42223 | 2019-10-15 |
| 1184138232 | Vanessa Renee Simmons | Dental Assistant | 302b Baker St, Fort Campbell, KY 42223 | 2017-11-28 |
| 1922451996 | Isabella Julson | Dental Assistant | Bldg2441 21st Street, Us Army Dental Activity, Fort Campbell, KY 42223 | 2016-07-14 |
| 1336595305 | Heidi Cameron | Acupuncturist | 2889b Idaho Avenue, Fort Campbell, KY 42223 | 2016-05-10 |
| 1649644154 | Nathan Silvey | Physician Assistant | Building 4179, Fort Campbell, KY 42223 | 2015-11-20 |
| 1396145306 | Blanchfield Army Community Hospital | Clinic/Center | Bldg 2403, Air Assault St and Indiana Ave, Fort Campbell, KY 42223 | 2014-08-27 |
| 1275948564 | Rodney C Merkley | Psychologist | Building 3929, Ft. Capmbell, KY 42223 | 2014-06-25 |
| 1659785053 | Blanchfield Army Community Hospital | Clinic/Center | Bldg 6747 A Shau Valley Road, Fort Campbell, KY 42223 | 2014-06-13 |
| Find all providers in zip 42223 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912153370 | Matthew Barret Curnutte | Emergency Medicine | 6106 Tennessee Ave, Fort Campbell, KY 37043 | 2008-08-15 |
| 1093911885 | Derek Mikel Carlson | Emergency Medicine | 7277 Nightstalker Way, Fort Campbell, KY 42223-5151 | 2007-06-27 |
| 1336266170 | Eric J Jacobson | Emergency Medicine | 7149 Blacksheep Run, Fort Campbell, KY 42223-5111 | 2007-03-26 |
| 1548210503 | Timothy S Talbot | Emergency Medicine | Nightstalker Way, Regiment Aid Station Bldg 7265, Fort Campbell, KY 42223-0596 | 2006-05-11 |
| 1154704500 | Kevin Lu | Emergency Medicine | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2015-07-02 |
| 1184007635 | Frank Thomas Dicker | Emergency Medicine | Blanchfield Army Community Hospital, 650 Joel Drive, Fort Campbell, KY 42223 | 2015-07-01 |
| 1013332881 | Nicholas Weiss | Emergency Medicine | 650 Joel Dr, Fort Campbell, KY 42223 | 2014-03-03 |
| 1861835845 | Joshua E Lefler | Emergency Medicine | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2013-04-09 |
| 1336487834 | Stephen Nicolas Dunay | Emergency Medicine | Blanchfield Army Community Hospital, 650 Joel Drive, Fort Campbell, KY 42223 | 2013-01-18 |
| 1255693180 | Christian G Jensen | Emergency Medicine | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2012-06-15 |
| Find all providers in FORT CAMPBELL | ||||
| City | FORT CAMPBELL |
| Zip Code | 42223 |
Please comment or provide details below to improve the information on DR. DEREK DOUGLAS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.