Provider Demographics
NPI: | 1205858917 |
---|---|
Name: | DOUGHERTY, DAVID CHARLES (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | DAVID |
Middle Name: | CHARLES |
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: | 3838 SAN DIMAS ST |
Mailing Address - Street 2: | SUITE A200 |
Mailing Address - City: | BAKERSFIELD |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 93301-2284 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 661-654-0200 |
Mailing Address - Fax: | 661-664-2855 |
Practice Address - Street 1: | 3838 SAN DIMAS ST |
Practice Address - Street 2: | SUITE A200 |
Practice Address - City: | BAKERSFIELD |
Practice Address - State: | CA |
Practice Address - Zip Code: | 93301-2284 |
Practice Address - Country: | US |
Practice Address - Phone: | 661-654-0200 |
Practice Address - Fax: | 661-664-2855 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-07-24 |
Last Update Date: | 2014-07-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | G47681 | 207R00000X, 207RA0201X, 207RC0000X, 207RC0200X, 207RE0101X, 207RG0100X, 207RG0300X, 207RH0003X, 207RI0008X, 207RI0200X, 207RN0300X, 207RP1001X, 207RR0500X, 207RS0010X, 207RA0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 207RA0201X | Allopathic & Osteopathic Physicians | Internal Medicine | Allergy & Immunology |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No | 207RG0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No | 207RI0008X | Allopathic & Osteopathic Physicians | Internal Medicine | Hepatology |
No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No | 207RS0010X | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine |
No | 207RA0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Adolescent Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | G476810 | Other | MEDICAL |
CA | A50774 | Medicare UPIN | |
CA | G476810 | Other | MEDICAL |