Provider Demographics
NPI:1083744775
Name:DOUGHERTY, PAUL J (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:J
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4353 PARK TERRACE DR
Mailing Address - Street 2:STE 150
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4631
Mailing Address - Country:US
Mailing Address - Phone:805-987-5300
Mailing Address - Fax:818-707-7668
Practice Address - Street 1:4353 PARK TERRACE DR
Practice Address - Street 2:STE 150
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4631
Practice Address - Country:US
Practice Address - Phone:805-987-5300
Practice Address - Fax:818-707-7668
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2022-07-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG70688207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G706880Medicaid
CAWG70688KMedicare ID - Type UnspecifiedLOS ANGELES
CA00G706880Medicaid
CAWG70688LMedicare ID - Type UnspecifiedCAMARILLO