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Individual

WILLIAM R DOUGHERTY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1331 MAESTAS RD, TAOS, NM 87571-6268
(575) 776-7806
(575) 224-7806
Mailing address
1331 MAESTAS RD, TAOS, NM 87571-6268
(575) 776-7806
(575) 224-7806

Taxonomy

Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
MD2010-0793
NM
2086S0127X
Trauma Surgery Physician
MD071147L
PA
2086S0127X
Trauma Surgery Physician
MD2010-0793
NM
2086S0127X
Trauma Surgery Physician
MD38986
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
932970
CAREFIRST MD BCBS
MD
Enumeration date
10/09/2006
Last updated
01/23/2023
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