Provider Demographics
NPI:1841397304
Name:DAUGHARTY, BARBARA A (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:DAUGHARTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-625-4000
Mailing Address - Fax:
Practice Address - Street 1:920 W IRONWOOD DR
Practice Address - Street 2:SUITE 201
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2463
Practice Address - Country:US
Practice Address - Phone:208-625-4965
Practice Address - Fax:208-625-4966
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6767207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine