Provider Demographics
NPI:1285652917
Name:DAUGHADAY, CARLOS C III (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:C
Last Name:DAUGHADAY
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8052
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-454-8917
Mailing Address - Fax:314-289-6389
Practice Address - Street 1:4921 PARKVIEW PL FL 8
Practice Address - Street 2:8TH FL
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-454-8917
Practice Address - Fax:314-289-6389
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-01-24
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Provider Licenses
StateLicense IDTaxonomies
MOR9329207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203305602Medicaid
ILENROLLEDMedicaid
IL$$$$$$$$$Medicaid
MO708010183Medicaid