Provider Demographics
NPI:1124041959
Name:DOUGLAS, RAYMOND S (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:S
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9675 BRIGHTON WAY STE 410
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5192
Mailing Address - Country:US
Mailing Address - Phone:310-363-8757
Mailing Address - Fax:310-363-8758
Practice Address - Street 1:9675 BRIGHTON WAY STE 410
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5192
Practice Address - Country:US
Practice Address - Phone:310-363-8757
Practice Address - Fax:310-363-8758
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77544207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A775440Medicaid
CA00A775440Medicaid
CAH62492Medicare UPIN
MIH62492Medicare UPIN