Individual
MATTHEW TRISTAN DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11335 SSG SIMS ST, FORT BLISS, TX 79918-8033
(850) 545-8528
Mailing address
4430 MISSOURI AVE, FORT LEONARD WOOD, MO 65473-9098
(850) 545-8528
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
—
Other
Enumeration date
05/29/2025
Last updated
05/29/2025
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