Individual
RYAN DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3787 SHIPYARD BLVD, WILMINGTON, NC 28403-6148
(910) 909-4163
Mailing address
311 ARBORETUM DR, WILMINGTON, NC 28405-6252
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
0010-1249
NC
Other
Enumeration date
09/07/2022
Last updated
09/07/2022
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