Provider Demographics
NPI:1730852021
Name:DOUGLAS, MALCOLM (PA)
Entity type:Individual
Prefix:
First Name:MALCOLM
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3900 W CHARLESTON BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1682
Mailing Address - Country:US
Mailing Address - Phone:702-362-2273
Mailing Address - Fax:702-786-1886
Practice Address - Street 1:3900 W CHARLESTON BLVD STE 170
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1682
Practice Address - Country:US
Practice Address - Phone:702-362-2273
Practice Address - Fax:702-786-1886
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-01
Last Update Date:2025-04-02
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty