Provider Demographics
NPI:1497208862
Name:DOUGHERTY, YINTING LO (PA-C)
Entity Type:Individual
Prefix:
First Name:YINTING
Middle Name:LO
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:YIN TING
Other - Middle Name:
Other - Last Name:LO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:UF ORTHOPAEDICS & SPORTS MEDICINE INSTITUTE
Mailing Address - Street 2:BOX 112727
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32611-2727
Mailing Address - Country:US
Mailing Address - Phone:352-273-7374
Mailing Address - Fax:
Practice Address - Street 1:UF ORTHOPAEDICS & SPORTS MEDICINE INSTITUTE
Practice Address - Street 2:BOX 112727
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611-2727
Practice Address - Country:US
Practice Address - Phone:352-273-7374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109634363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018414000Medicaid
FLIR467ZMedicare PIN