Provider Demographics
NPI:1275532657
Name:DAUGHETY, TED W (MD)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:W
Last Name:DAUGHETY
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 1:1500 SW 10TH AVE
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604
Mailing Address - Country:US
Mailing Address - Phone:785-354-6241
Mailing Address - Fax:785-270-4343
Practice Address - Street 1:2860 SW MISSION WOODS DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-5604
Practice Address - Country:US
Practice Address - Phone:785-354-9591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS421292207RP1001X
KS0421292207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSB69126Medicare UPIN