# DR. JOHN DAUGHERTY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1124076922
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | C-5390 | AR | Yes |

## Other

- **Enumeration date:** 05/04/2006
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1569 | SCHUMACHER GR TSG ID | AR |
| 01 | — | 16194-1 | FAA | AR |
| 01 | — | 5335127 | AETNA | AR |