Provider Demographics
NPI:1689075889
Name:DOHERTY, SCOTT M (PA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:DOHERTY
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Gender:M
Credentials:PA
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Mailing Address - Street 1:2827 FORT MISSOULA RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7408
Mailing Address - Country:US
Mailing Address - Phone:406-327-4585
Mailing Address - Fax:406-327-4502
Practice Address - Street 1:2230 N RESERVE ST STE 402
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1364
Practice Address - Country:US
Practice Address - Phone:406-721-0533
Practice Address - Fax:406-728-4463
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2023-09-18
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Provider Licenses
StateLicense IDTaxonomies
MTMED-PAC-LIC-34654363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant