Provider Demographics
NPI:1578523288
Name:DOUGHERTY, HUGH K (MD)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:K
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:P O BOX 990
Mailing Address - Street 2:102 W 18TH ST
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1911
Mailing Address - Country:US
Mailing Address - Phone:270-707-2100
Mailing Address - Fax:270-707-2103
Practice Address - Street 1:219 W 17TH ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1911
Practice Address - Country:US
Practice Address - Phone:270-886-5141
Practice Address - Fax:270-885-1877
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY20877208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64208770Medicaid
KY0365401Medicare PIN
KY1387501Medicare PIN
KY64208770Medicaid
KY0273302Medicare PIN