Individual
TIMOTHY JOSEPH DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
501 DR MICHAEL DEBAKEY DR, LAKE CHARLES, LA 70601-5724
(337) 312-8249
(337) 312-6711
Mailing address
711 DR MICHAEL DEBAKEY DR, LAKE CHARLES, LA 70601-5785
(337) 312-8247
(337) 493-4355
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP08206
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2386611
—
LA
Enumeration date
02/25/2015
Last updated
05/01/2017
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