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Dr. Jerry Edward Douglas, MD
Family Medicine Physician in Clearlake, California
NPI 1285603621

Jerry Edward Douglas is a Family Medicine Physician based in Ukiah, CA. Jerry Edward Douglas practices in Clearlake, CA and has the professional credentials of MD. The NPI Number for Jerry Edward Douglas is 1285603621 and holds a License No. 01032101A (California).

The current practice location address for Jerry Edward Douglas is 15322 Lakeshore Dr, Clearlake, CA and can be reached out via phone at 707-994-0303 and via fax at 707-995-9447.

Location: 15322 Lakeshore Dr, Clearlake, CA, 95482-6540
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1285603621
Provider Name
Jerry Edward Douglas
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
15322 Lakeshore Dr, Clearlake, CA, 95482-6540
Phone Number
707-994-0303
Fax Number
707-995-9447
Provider Enumeration Date
03/17/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
200100490 05 IN
000000190581 01 IN ANTHEM PROVIDER NUMBER
162528 01 IN PHCS PID NUMBER
11484440 01 IN CAQH NUMBER
institution
Provider Business Practice Location Address Details
Address
15322 Lakeshore Dr
City
Clearlake
State
California
Zip
95422-9814
Phone Number
707-994-0303
Fax Number
707-995-9447
person
Provider Business Mailing Address Details
Address
15322 Lakeshore Dr
City
Clearlake
State
California
Zip
95422-9814
Phone Number
707-994-0303
Fax Number
707-995-9447
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Family Medicine
Speciality
-
Taxonomy
207Q00000X
License No.
01032101A (Indiana)
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
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