Provider Demographics
NPI:1528263498
Name:DOUGLAS, OXANA V (MD)
Entity type:Individual
Prefix:
First Name:OXANA
Middle Name:V
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7717 COLLIER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34114-2768
Mailing Address - Country:US
Mailing Address - Phone:239-624-8220
Mailing Address - Fax:239-624-8221
Practice Address - Street 1:7717 COLLIER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-2768
Practice Address - Country:US
Practice Address - Phone:239-624-8220
Practice Address - Fax:239-624-8221
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42939207Q00000X
FLME119711207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHZ163YOtherMEDICARE
FL013496000Medicaid
FL14X36OtherBCBS
FLHZ163ZMedicare UPIN