Provider Demographics
NPI:1114935210
Name:DOUGHERTY, ROBERT JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAMES
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 HIGHWAY 71 W STE B1
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-3937
Mailing Address - Country:US
Mailing Address - Phone:512-581-5016
Mailing Address - Fax:512-581-5022
Practice Address - Street 1:441 HIGHWAY 71 W STE B1
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3937
Practice Address - Country:US
Practice Address - Phone:512-581-5016
Practice Address - Fax:512-581-5022
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00754FMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TXH44653Medicare UPIN