# BRIAN DOUGHERTY

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

## Provider details

- **NPI number:** 1194091991
- **Gender:** Man
- **Credential:** MB, BCH, BAO

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 036.136528 | IL | Yes |
| 208600000X | Surgery Physician | 125.062127 | IL | — |
| 390200000X | Student in an Organized Health Care Education/Training Program | 125062127 | IL | — |

## Other

- **Enumeration date:** 03/26/2012
- **Last updated:** 11/21/2024