Basic Information
Provider Information | |||||||||
NPI: | 1437147287 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SAYLOR | ||||||||
FirstName: | DOUGLAS | ||||||||
MiddleName: | JAY | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 501 LAPEER AVE | ||||||||
Address2: |   | ||||||||
City: | SAGINAW | ||||||||
State: | MI | ||||||||
PostalCode: | 486071208 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9897596400 | ||||||||
FaxNumber: | 9897596423 | ||||||||
Practice Location | |||||||||
Address1: | 3175 PROFESSIONAL DRIVE | ||||||||
Address2: |   | ||||||||
City: | BAY CITY | ||||||||
State: | MI | ||||||||
PostalCode: | 487062823 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9896673377 | ||||||||
FaxNumber: | 9896679991 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/06/2005 | ||||||||
LastUpdateDate: | 04/09/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/09/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4301046517 | MI | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | 190 | 01 |   | COMMUNITY CHOICE OF MICHI | OTHER | 381908328 | 01 |   | FIRST HEALTH | OTHER | 4529588 | 05 | MI |   | MEDICAID | 0998824 | 01 |   | HEALTHPLUS OF MICHIGAN | OTHER | 381908328 | 01 |   | TRICARE | OTHER | 193892 | 01 |   | CIGNA | OTHER | 700G361110 | 01 |   | BCBS OF MI | OTHER | P71799 | 01 |   | BLUE CARE NETWORK OF MICH | OTHER | P00086038 | 01 |   | RAILROAD MEDICARE | OTHER | 112057 | 01 |   | GREAT LAKES HEALTH PLAN | OTHER |