Individual
RUSSELL DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1300 N MAIN ST, RUSHVILLE, IN 46173-1198
(765) 932-7439
(765) 932-7410
Mailing address
1300 N MAIN ST, RUSHVILLE, IN 46173-1198
(765) 932-4111
(765) 932-7505
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01042648A
IN
207R00000X
Internal Medicine Physician
01042648A
IN
208000000X
Pediatrics Physician
01042648A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000599467
ANTHEM BCBS
IN
05
—
200001980
—
IN
Enumeration date
10/14/2005
Last updated
02/17/2025
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