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Individual

DR. SEAN MICHAEL DOUGHERTY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.P.M.

Contact information

Practice address
1620 PENNSYLVANIA AVE STE A, FAIRFIELD, CA 94533-3509
(707) 426-5644
(707) 426-3156
Mailing address
1620 PENNSYLVANIA AVE STE A, FAIRFIELD, CA 94533-3509
(707) 426-5644
(707) 426-3156

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
E5009
CA
213EP1101X
Primary Podiatric Medicine Podiatrist
E5009
CA
213ES0000X
Sports Medicine Podiatrist
E5009
CA
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E5009
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P01083197
MEDICARE RAILROAD
CA
Enumeration date
08/27/2009
Last updated
09/02/2020
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