Individual
JOSEPH EDWARD DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 N STATE ST, C/O DEPARTMENT OF EMERGENCY MEDICINE, JACKSON, MS 39216-4500
(601) 984-5570
Mailing address
2500 N STATE ST, C/O DEPARTMENT OF EMERGENCY MEDICINE, JACKSON, MS 39216-4500
(601) 984-5570
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
24034
MS
207P00000X
Emergency Medicine Physician
T-2663
MS
2086S0102X
Surgical Critical Care Physician
24034
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03837264
—
MS
Enumeration date
03/28/2013
Last updated
11/21/2019
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