NPI 1174020598

Kevin Andrew Douglas, DPM

Practitioner Foot & Ankle Surgery Podiatrist Coram, NY

Practice location

Address: 100 Middle Country Rd, Coram, NY 11727-4412
Phone: (631) 696-9636
Fax: (631) 696-9635
Mailing address: 1000 Montauk Hwy, West Islip, NY 11795-4927

Registered specialties (2)

Foot & Ankle Surgery Podiatrist Primary

Podiatric Medicine & Surgery Service Providers Taxonomy 213ES0103X Licence N007168 (NY)

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Student in an Organized Health Care Education/Training Program

Student, Health Care Taxonomy 390200000X

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Registry record

NPI: 1174020598
Entity type: Individual
Sex (as registered): Male
NPI issued: 11 Apr 2018
Record last updated: 6 Jun 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.