Provider Demographics
NPI:1316994130
Name:LITCHFIELD, DOUGLAS W (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:W
Last Name:LITCHFIELD
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 1:200 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5675
Mailing Address - Country:US
Mailing Address - Phone:701-222-3937
Mailing Address - Fax:701-222-8805
Practice Address - Street 1:200 S 5TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5675
Practice Address - Country:US
Practice Address - Phone:701-222-3937
Practice Address - Fax:701-222-8805
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND6572207W00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1456436Medicaid
ND11741OtherBCBS - MAIN CLINIC
180016368OtherRAILROAD MEDICARE ID
SD7766670Medicaid
08-01407OtherMEDICA - SURGERY CENTER
ND17674Medicaid
ND25958OtherBCBS - NORTH CLINIC
08-01405OtherMEDICA - MAIN CLINIC
08-01406OtherMEDICA - NORTH CLINIC
21370OtherSIOUX VALLEY HEALTH PLAN
48824144240OtherPREFERRED ONE
MT3501056Medicaid
ND17674Medicaid