| Doctor Name: | WILLIAM GLEN HAMMOND DOUGLAS |
| NPI Number: | 1477793727 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | G46175 |
| Business Practice Address: | 200 E Hackett Rd Modesto, CA - 953589415 |
| Business Phone Number: | 2095255676 |
| Business Fax Number: | |
| Mailing Address: | Po Box 255767, SACRAMENTO |
| State: | CA |
| Postal Code: | 958655767 |
| Phone Number: | 2095255676 |
| Fax Number: | |
| NPI Enumeration Date: | 02/26/2009 |
| NPI Last Update Date: | 02/26/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | G46175 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |