Provider Demographics
NPI:1982713699
Name:DAUGHERTY, JOSEPH F III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:F
Last Name:DAUGHERTY
Suffix:III
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 1:806 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2420
Mailing Address - Country:US
Mailing Address - Phone:859-371-2600
Mailing Address - Fax:859-372-5923
Practice Address - Street 1:806 SCOTT ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-2420
Practice Address - Country:US
Practice Address - Phone:859-371-2600
Practice Address - Fax:859-372-5923
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039319D207R00000X
KY22022207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
310794775OtherGREAT WEST
310794775029OtherAETNA
310794775AOtherHUMANA
KY64786122Medicaid
OH0327159Medicaid
000000005541OtherANTHEM
0420801OtherUNITED HEALTH CARE
310794775OtherGREAT WEST
OHDA0435982Medicare ID - Type Unspecified
0420801OtherUNITED HEALTH CARE