Provider Demographics
NPI:1902849557
Name:DAUGHERTY, STEVEN K (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:K
Last Name:DAUGHERTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BRIGHTON
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-8082
Mailing Address - Country:US
Mailing Address - Phone:417-581-4027
Mailing Address - Fax:
Practice Address - Street 1:300 BRIGHTON
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-8082
Practice Address - Country:US
Practice Address - Phone:417-581-4027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3J78207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
107059OtherBLUE CROSS/BLUE SHIELD
MO207971102Medicaid
E40876Medicare UPIN
MO207971102Medicaid