Individual
MICHAEL DOUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2500 QUANTUM LAKES DR, SUITE 108, BOYNTON BEACH, FL 33426-8324
(561) 244-3627
(561) 244-9627
Mailing address
2500 QUANTUM LAKES DR, SUITE 108, BOYNTON BEACH, FL 33426-8324
(561) 244-3627
(561) 244-9627
Taxonomy
Speciality
Code
Description
License number
State
177F00000X
Lodging Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
415
EMPLOYEE #
FL
Enumeration date
08/21/2006
Last updated
07/08/2007
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