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Individual
LAURA WAIKART DOUGHERTY
Active
Individual
LAURA WAIKART DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
28749
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AA16666874
MEDICARE PTAN
SC
01
—
TL28749
SC MEDICAL LICENSE #
SC
Enumeration date
06/04/2006
Last updated
11/16/2015
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