Provider Demographics
NPI:1851564256
Name:DOUGLAS, JILLIAN LEIGH (DO)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:LEIGH
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:LEIGH
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:206 SKYLAR DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9383
Mailing Address - Country:US
Mailing Address - Phone:304-989-4040
Mailing Address - Fax:
Practice Address - Street 1:206 SKYLAR DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9383
Practice Address - Country:US
Practice Address - Phone:681-318-3586
Practice Address - Fax:681-318-3587
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2423207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine