SAMUEL DOUGLASS DO NPI 1063801678

NPI Information

  • NPI: 1063801678
  • Provider Name: SAMUEL DOUGLASS, DO
  • Classification: Radiology - 2085R0202X
  • Specialization: Diagnostic Radiology
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1055 N CURTIS RD
    BOISE, ID
    ZIP 83706
  • Phone: (208) 367-2121

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NPI Details

Samuel Douglass, DO is a diagnostic radiology radiology in Boise, ID with 11 years of experience. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. Samuel Douglass, DO NPI is 1063801678. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: ROCKY VISTA UNIVERSITY COLLEGE OF OSTEOPATHIC MED
Graduation Year:2015

The provider's business location address is:

1055 N CURTIS RD
BOISE, ID
ZIP 83706-309
Phone: (208) 367-2121
Fax: (706) 596-6720

The NPI 1063801678 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/20/2015 and was last updated on 4/18/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12085R0202XRadiologyDiagnostic RadiologyOP61322937WASHINGTONNo
22085R0202XRadiologyDiagnostic RadiologyDO219310OREGONNo
32085R0202XRadiologyDiagnostic Radiology1539NEBRASKANo
42085R0202XRadiologyDiagnostic RadiologyOC-0433IDAHOYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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