Individual
TIMOTHY DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
636 DEL PRADO BLVD S, CAPE CORAL, FL 33990-2668
(239) 772-6513
Mailing address
6896 W SNOWVILLE RD, BRECKSVILLE, OH 44141-3214
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME76221
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
221582
AMERIGROUP
FL
05
—
254620500
—
FL
01
—
44660
BLUE CROSS BLUE SHIELD
FL
01
—
7939666
AETNA
FL
Enumeration date
04/19/2006
Last updated
01/03/2008
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