Individual
BRIAN DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MB, BCH, BAO
Contact information
Practice address
1562 MITSCHER AVE STE 250, NORFOLK, VA 23551-2423
(757) 443-3872
Mailing address
1562 MITSCHER AVE STE 250, NORFOLK, VA 23551-2423
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036.136528
IL
208600000X
Surgery Physician
125.062127
IL
390200000X
Student in an Organized Health Care Education/Training Program
125062127
IL
Other
Enumeration date
03/26/2012
Last updated
11/21/2024
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