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Contact Information

KELLY M DOUGLAS, MD
1125 MADISON ST
JEFFERSON CITY, MO65101-5227
 Phone: 573-632-5000
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Emergency Medicine

207P00000X 93 Physician/Emergency Medicine
 

Internal Medicine

207R00000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for KELLY M DOUGLAS · (Female)

NPI Number 1366889909
Status Active
Credentials MD
Entity Individual
Enumeration date 05/22/2013
Last updated 09/14/2022 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • IA License # MD-44341
  • IA License # R-9673
  • MO License # 2014014696
  • MO License # 2021016294
Hospital affiliation(s)
  • CAPITAL REGION MEDICAL CENTER - (Acute Care)
    1125 MADISON ST
    JEFFERSON CITY, MO 65102
  • MOBERLY REGIONAL MEDICAL CENTER - (Acute Care)
    1515 UNION AVE
    MOBERLY, MO 65270
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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