Organization
CAPE CORAL EMERGENCY PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY DOUGHERTY (MEDICAL DOCTOR)
(239) 772-6513
Entity
Organization
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CC0843
RAILROAD MEDICARE
FL
Enumeration date
04/18/2006
Last updated
10/17/2007
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