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Individual
CHRISTOPHER R DOUGHERTY
Active
Individual
CHRISTOPHER R DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AA
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
2012029911
MO
367H00000X
Anesthesiologist Assistant
Primary
75000180A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720336548
—
MO
01
—
431560263
TRICARE
MO
01
—
P01129104
RR MCR
MO
Enumeration date
08/28/2012
Last updated
07/15/2024
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