# CHRISTOPHER R DOUGHERTY

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

## Provider details

- **NPI number:** 1720336548
- **Gender:** Man
- **Credential:** AA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 367H00000X | Anesthesiologist Assistant | 2012029911 | MO | — |
| 367H00000X | Anesthesiologist Assistant | 75000180A | IN | Yes |

## Other

- **Enumeration date:** 08/28/2012
- **Last updated:** 07/15/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1720336548 | — | MO |
| 01 | — | 431560263 | TRICARE | MO |
| 01 | — | P01129104 | RR MCR | MO |