DR. DEREK BRADLEY DOUGLAS (NPI# 1902307762) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902307762 |
| Entity Type | Individual |
| Full Name | DR. DEREK BRADLEY DOUGLAS |
| Credential | D.O. |
| Practice Address |
9040 Fitzsimmons Dr Joint Base Lewis Mcchord WA 98431-1000 |
| Practice Telephone | 2539682997 |
| Mailing Telephone | 2539682997 |
| Enumeration Date | 2018-02-26 |
| Last Update Date | 2019-11-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | OP60981147 | WA | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740759349 | Derek Anthony Douglas | Occupational Therapist | 13950 Brandywine Rd, Brandywine, MD 20613-5815 | 2018-11-13 |
| 1154747657 | Derek Douglas | Emergency Medicine | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2014-03-10 |
| Street Address |
9040 FITZSIMMONS DR |
| City | JOINT BASE LEWIS MCCHORD |
| State | WA |
| Zip Code | 98431-1000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902411929 | Riordan Ann Dail | Student in an Organized Health Care Education/Training Program | 9040 Fitzsimmons Dr, Joint Base Lewis Mcchord, WA 98431-1000 | 2020-09-15 |
| 1477165496 | John Anthony Poglodzinski | Student in an Organized Health Care Education/Training Program | 9040 Fitzsimmons Dr, Joint Base Lewis Mcchord, WA 98431-1000 | 2020-08-20 |
| 1225686686 | Nicholas Tommas | Student in an Organized Health Care Education/Training Program | 9040 Fitzsimmons Dr, Joint Base Lewis Mcchord, WA 98431-1000 | 2019-08-29 |
| 1902454473 | Rebecca Jane Doubet | Student in an Organized Health Care Education/Training Program | 9040 Fitzsimmons Dr, Joint Base Lewis Mcchord, WA 98431-1000 | 2019-08-28 |
| 1912467317 | Jason Lamm | Student in an Organized Health Care Education/Training Program | 9040 Fitzsimmons Dr, Joint Base Lewis Mcchord, WA 98431-1000 | 2019-03-21 |
| 1457819880 | Joseph Ryan Hitt | Student in an Organized Health Care Education/Training Program | 9040 Fitzsimmons Dr, Joint Base Lewis Mcchord, WA 98431-1000 | 2019-03-05 |
| 1528525409 | Nicole Lopez | Student in an Organized Health Care Education/Training Program | 9040 Fitzsimmons Dr, Joint Base Lewis Mcchord, WA 98431-1000 | 2019-02-27 |
| 1235695784 | Hannah Robinson | Student in an Organized Health Care Education/Training Program | 9040 Fitzsimmons Dr, Joint Base Lewis Mcchord, WA 98431-1000 | 2019-02-20 |
| 1609332428 | William E Rutan | Student in an Organized Health Care Education/Training Program | 9040 Fitzsimmons Dr, Joint Base Lewis Mcchord, WA 98431-1000 | 2019-02-17 |
| 1659837631 | Aimee Nicole Rambie | Student in an Organized Health Care Education/Training Program | 9040 Fitzsimmons Dr, Joint Base Lewis Mcchord, WA 98431-1000 | 2019-02-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497212260 | Catrina Renee Grugin | Registered Nurse | Madigan Army Medical Center, Attn Mchj-clq-c, 9040 Jackson Ave, Tacoma, WA 98431 | 2019-02-27 |
| 1801307681 | Bianca Gomez | Dental Assistant | Bldg 9900 Lincoln Street, Jblm, WA 98431 | 2017-10-19 |
| 1184133225 | Darren Paris | Registered Nurse | Madigan Army Medical Center 9040 Jackson Ave., Attn: Mchj-clq-c, Tacoma, WA 98431 | 2017-09-20 |
| 1922538206 | Sarah Frerichs | Dentist | Madigan Annex, Second Floor, Bldg. 9900, Apo, AA 98431 | 2017-06-19 |
| 1740736495 | Misty Hill | Dental Assistant | 9119 Mill Park Ave, Tacoma, WA 98431 | 2016-08-31 |
| 1336695535 | Jacqueline D Massouda | Dentist | Jblm Dentac, 9900 Lincoln Sreet, 2nd Floor, Apo, AA 98431 | 2016-08-28 |
| 1609239375 | Gregg V Palmer | Licensed Practical Nurse | 17th and C Street, Bldg 11582, Tacoma, WA 98431 | 2016-03-31 |
| 1114323904 | Deanna Sheets | Nurse Practitioner | 911 Mil Park Ave, Tacoma, WA 98431 | 2014-11-06 |
| 1679905434 | Austin William Schaar | Dentist | Building 9900, 2nd Floor, Tacoma, WA 98431 | 2013-08-05 |
| 1518209758 | Maurice Ibrahim Khayat | Internal Medicine | 9040 Jackson Ave Mche-qd (creds), Tacoma, WA 98431 | 2013-03-26 |
| Find all providers in zip 98431 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235529702 | Matti Pekka Asuma | General Practice | 9040a Fitzsimmons Drive Department of Orthopaedics, Joint Base Lewis Mcchord, WA 98431-1000 | 2015-02-04 |
| 1578853024 | Albert J Lee | General Practice | Soldier Centered Medical Home, Bldg 13815, Joint Base Lewis Mcchord, WA 98433-1000 | 2011-04-17 |
| 1619433885 | Micheal Irelan | General Practice | 9040 Jackson Ave, Joint Base Lewis Mcchord, WA 98431-1000 | 2019-02-13 |
| 1457816811 | Arron Michael Smith | General Practice | 9040 Fitzsimmons Dr, Joint Base Lewis Mcchord, WA 98431-1000 | 2019-02-09 |
| 1750846747 | Jared Ray Seaman | General Practice | 9040 Fitzsimmons Dr, Joint Base Lewis Mcchord, WA 98431-1000 | 2019-02-05 |
| 1427513639 | Logan August Dobbe | General Practice | 9040 Jackson Ave, Joint Base Lewis Mcchord, WA 98431-1000 | 2019-02-01 |
| 1972000925 | Stephanie Katherine Skelly | General Practice | 9040 Jackson Avenue, Joint Base Lewis Mcchord, WA 98431-7141 | 2018-04-06 |
| 1013413335 | Colin Alexander Henderson | General Practice | 9040a Jackson Avenue, Joint Base Lewis Mcchord, WA 98431 | 2018-04-04 |
| 1902302300 | Kelsey Elizabeth Robinson | General Practice | 9040 Fitzsimmons Dr, Joint Base Lewis Mcchord, WA 98431-1000 | 2018-04-04 |
| 1124524624 | Jacob Braun | General Practice | 9040 Fitzsimmons Dr, Joint Base Lewis Mcchord, WA 98431-1000 | 2018-04-03 |
| Find all providers in JOINT BASE LEWIS MCCHORD | ||||
| City | JOINT BASE LEWIS MCCHORD |
| Zip Code | 98431 |
Please comment or provide details below to improve the information on DR. DEREK BRADLEY 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.