Provider Demographics
NPI:1720054299
Name:DOUGLASS, MARION (MD)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:
Last Name:DOUGLASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1551 E TANGERINE RD
Mailing Address - Street 2:STE. 3
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-6213
Mailing Address - Country:US
Mailing Address - Phone:520-901-6255
Mailing Address - Fax:520-901-6173
Practice Address - Street 1:6050 N. CORONA RD.
Practice Address - Street 2:STE 3
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704
Practice Address - Country:US
Practice Address - Phone:520-469-8700
Practice Address - Fax:520-469-8708
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2016-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ327132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C71735Medicare UPIN