Individual
DR. JACOB RANDALL DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
10701 EAST BLVD, CLEVELAND, OH 44106-1702
(216) 791-3800
(216) 421-3038
Mailing address
730 GOODLETTE RD N, STE 102, NAPLES, FL 34102-5617
(239) 430-3668
(239) 692-9436
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO4179
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/08/2017
Last updated
07/21/2022
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