Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Jerry Edward Douglas, MD

Individual provider Family Medicine Physician · NPI 1285603621

Dr. Jerry Edward Douglas, MD is a Family Medicine Physician in Clearlake, California. Licensed in California and Indiana. Registered with an NPI since 2006.

Licensed in
CA, IN
In the registry since
2006
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

15322 Lakeshore Dr Ste 202
Clearlake, CA 95422-9814
Phone: (707) 994-0303
Fax: (707) 995-9447
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Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 53653 (CA)
Family Medicine Physician Taxonomy 207Q00000X · Licence 01032101A (IN)
Family Medicine Physician Taxonomy 207Q00000X · Licence C53653 (CA)

Record details

NPI number1285603621
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMarch 17, 2006
Last updated in NPPESApril 2, 2018
Mailing address333 Laws Ave, Ukiah, CA 95482-6540

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