Individual
MR. JOHN F DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3303 FERN VALLEY RD, LOUISVILLE, KY 40213-3529
(502) 964-4889
(502) 964-9769
Mailing address
PO BOX 950248, LOUISVILLE, KY 40295-0248
(502) 489-5730
(502) 489-5733
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
PA416
KY
363A00000X
Physician Assistant
Primary
PA416
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95002689
—
KY
Enumeration date
05/26/2006
Last updated
01/17/2015
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