Provider Demographics
NPI:1942238027
Name:DOUGHERTY, JOHN J (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1010 CARONDELET DR STE 220
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4822
Mailing Address - Country:US
Mailing Address - Phone:816-941-1600
Mailing Address - Fax:816-941-1699
Practice Address - Street 1:1010 CARONDELET DR STE 220
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4822
Practice Address - Country:US
Practice Address - Phone:816-941-1600
Practice Address - Fax:816-941-1699
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2010-09-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO104398207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO247956733Medicaid
F83805Medicare UPIN