Individual
DR. THOMAS JOSEPH DOUGHERTY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1111 DELAFIELD ST, #203, WAUKESHA, WI 53188-3417
(262) 542-9531
Mailing address
1111 DELAFIELD ST, #203, WAUKESHA, WI 53188-3417
(262) 542-9531
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19095
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30119600
—
WI
Enumeration date
12/07/2005
Last updated
07/08/2007
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