Individual
CHARLES DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
R6070
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100732
HEALTHLINK
MO
01
—
1200163
UHC
MO
01
—
17699
BCB
MO
01
—
40000261
AETNA
MO
01
—
40420
GHP
MO
01
—
5724V34311
HEALTHCARE USA
MO
Enumeration date
11/08/2005
Last updated
09/21/2012
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