Provider Demographics
NPI:1255365433
Name:DAUGHERTY, GEOFFREY WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:WAYNE
Last Name:DAUGHERTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 41144
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-1144
Mailing Address - Country:US
Mailing Address - Phone:251-219-3668
Mailing Address - Fax:251-219-3715
Practice Address - Street 1:1504 SPRING HILL AVE
Practice Address - Street 2:VA OUTPATIENT CLINIC
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3207
Practice Address - Country:US
Practice Address - Phone:251-219-3668
Practice Address - Fax:251-219-3715
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL11128207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine