| Doctor Name: | MR. MARK WILLIAM DOUGLASS |
| NPI Number: | 1023283660 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 412 Sw 12th Ave Portland, OR - 972052329 |
| Business Phone Number: | 5032287134 |
| Business Fax Number: | |
| Mailing Address: | Po Box 8459, PORTLAND |
| State: | OR |
| Postal Code: | 972078459 |
| Phone Number: | 5032380769 |
| Fax Number: | |
| NPI Enumeration Date: | 04/24/2008 |
| NPI Last Update Date: | 06/19/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171M00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Case Manager/Care Coordinator |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee |