# DR. MARK CHRYSOSTOM DOUGHERTY

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

## Provider details

- **NPI number:** 1265925234
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207T00000X | Neurological Surgery Physician | MD-56844 | IA | Yes |
| 207T00000X | Neurological Surgery Physician | R-11336 | IA | — |
| 390200000X | Student in an Organized Health Care Education/Training Program | — | MD | Yes |

## Other

- **Enumeration date:** 06/13/2018
- **Last updated:** 09/02/2026