Provider Demographics
NPI:1316948987
Name:GAITHER, DOUGLAS HAMILTON (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:HAMILTON
Last Name:GAITHER
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 1:5280 BELLE AVE.
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807
Mailing Address - Country:US
Mailing Address - Phone:615-516-4291
Mailing Address - Fax:
Practice Address - Street 1:5820 BELLE AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2782
Practice Address - Country:US
Practice Address - Phone:615-516-4291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA38712207P00000X
IL036.126675207P00000X
TN11044207P00000X
CO44100207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036.126675OtherMEDICAL LICENSE NUMBER
IA38712OtherMEDICAL LICENSE NUMBER
2008425OtherBCBS
TN11044OtherMEDICAL LICENSE NUMBER
CO44100OtherMEDICAL LICENSE NUMBER
CO44100OtherMEDICAL LICENSE NUMBER
3177736Medicare ID - Type Unspecified