Individual
DR. JOHN DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1409 BRADEN ST, JACKSONVILLE, AR 72076-3720
(501) 982-0576
(501) 982-0041
Mailing address
1409 BRADEN ST, JACKSONVILLE, AR 72076-3720
(501) 982-0576
(501) 982-0041
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
C-5390
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1569
SCHUMACHER GR TSG ID
AR
01
—
16194-1
FAA
AR
01
—
5335127
AETNA
AR
Enumeration date
05/04/2006
Last updated
03/07/2023
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