Provider Demographics
NPI:1043252505
Name:DAUGHERTY, EDWARD PAYSON (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:PAYSON
Last Name:DAUGHERTY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:151 NARROWS PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-8637
Mailing Address - Country:US
Mailing Address - Phone:205-444-9550
Mailing Address - Fax:205-314-3360
Practice Address - Street 1:151 NARROWS PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-8637
Practice Address - Country:US
Practice Address - Phone:205-444-9550
Practice Address - Fax:205-314-3360
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALDO-408207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF93991Medicare UPIN