Provider Demographics
NPI:1831260470
Name:FOLSOM, DOUGLAS L (MD)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:L
Last Name:FOLSOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3934 ROCKY POINT DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6902
Mailing Address - Country:US
Mailing Address - Phone:925-978-9643
Mailing Address - Fax:925-978-9029
Practice Address - Street 1:3934 ROCKY POINT DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6902
Practice Address - Country:US
Practice Address - Phone:925-978-9643
Practice Address - Fax:925-978-9029
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G209611207RS0012X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG209610OtherBCBS
CAZZZ14143ZOtherBCBS
CA00G209610Medicaid
CAZZZ14143ZOtherBCBS
CA00G209611Medicare PIN