Provider Demographics
NPI:1902858988
Name:ST CLAIR, DOUGLAS ARTHUR (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ARTHUR
Last Name:ST CLAIR
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 1:5831 S A1A HWY
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32951-3702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:325 5TH AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4273
Practice Address - Country:US
Practice Address - Phone:321-821-4889
Practice Address - Fax:321-821-4890
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69436207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379311700Medicaid
FL379311700Medicaid
FL28287ZMedicare PIN
FL28287UMedicare PIN