Provider Demographics
NPI:1760465843
Name:DAUGHERTY, WILLIAM T (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:T
Last Name:DAUGHERTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1050 SE MONTEREY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4512
Mailing Address - Country:US
Mailing Address - Phone:772-288-2400
Mailing Address - Fax:772-419-0155
Practice Address - Street 1:1050 SE MONTEREY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4512
Practice Address - Country:US
Practice Address - Phone:772-288-2400
Practice Address - Fax:772-419-0155
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2009-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME494222084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC380083Medicare UPIN
FL023353ZMedicare ID - Type Unspecified