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Organization
DAUGHERTY AND DAUGHERTY MEDICAL CLINIC PA
Active
Organization
DAUGHERTY AND DAUGHERTY MEDICAL CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOE D DAUGHERTY M.D. (PRESIDENT)
(501) 982-0576
Entity
Organization
Contact information
Practice address
1409 BRADEN ST, JACKSONVILLE, AR 72076-3720
(501) 982-0576
(501) 982-0041
Mailing address
1409 WEST BRADEN, JACKSONVILLE, AR 72076
(501) 982-0576
(501) 982-0041
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04D0466369
CLIA
AR
05
—
104806002
—
AR
01
—
CS4952
RR MCR CLINIC #
—
Enumeration date
05/03/2006
Last updated
02/07/2020
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