Provider Demographics
NPI:1447502653
Name:PAI, DOUGLAS WILLIAM (DOM)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:WILLIAM
Last Name:PAI
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CROSS RANCH RD
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NM
Mailing Address - Zip Code:87056-9764
Mailing Address - Country:US
Mailing Address - Phone:505-717-9185
Mailing Address - Fax:
Practice Address - Street 1:105 BROADWAY
Practice Address - Street 2:
Practice Address - City:MORIARTY
Practice Address - State:NM
Practice Address - Zip Code:87035
Practice Address - Country:US
Practice Address - Phone:505-717-9185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1015171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist