Provider Demographics
NPI:1306057369
Name:JEFFREY, DOUGLAS DUART (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:DUART
Last Name:JEFFREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 TEAKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-6533
Mailing Address - Country:US
Mailing Address - Phone:214-557-0736
Mailing Address - Fax:
Practice Address - Street 1:2201 S CLEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4110
Practice Address - Country:US
Practice Address - Phone:254-526-7523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7307207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AE932OtherBCBS
TX8AS826OtherBCBS
TX188106201Medicaid
TX8AB482OtherBCBS
TX188106202Medicaid
TX8AE922OtherBCBS
TX8X9292OtherBCBS
TX188106204Medicaid
TX188106203Medicaid
TX188106205Medicaid
TX8AB508OtherBCBS
TX8AE932OtherBCBS
TX8AE922OtherBCBS
TX8X9292OtherBCBS
TX8F6601Medicare PIN
TX8J7643Medicare PIN
TX8J7644Medicare PIN