Provider Demographics
NPI:1407916190
Name:DOUGHERTY, MINNIE (PA)
Entity Type:Individual
Prefix:
First Name:MINNIE
Middle Name:
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:COMMANDER USA MEDDAC AK MCUC MMD ATTN CREDENTIALS
Mailing Address - Street 2:1060 GAFFNEY RD STE 7440
Mailing Address - City:FT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-7440
Mailing Address - Country:US
Mailing Address - Phone:907-353-5418
Mailing Address - Fax:907-353-4847
Practice Address - Street 1:COMMANDER USA MEDDAC AK MCUC MMD ATTN CREDENTIALS
Practice Address - Street 2:1060 GAFFNEY RD STE 7440
Practice Address - City:FT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-7440
Practice Address - Country:US
Practice Address - Phone:907-353-5418
Practice Address - Fax:907-353-4847
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical