Individual
DOUGLAS A DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2020 PALOMINO LANE, SUITE 100, LAS VEGAS, NV 89106-4894
(702) 759-8600
(702) 384-1518
Mailing address
2020 PALOMINO LANE, SUITE 100, LAS VEGAS, NV 89106-4894
(702) 759-8600
(702) 384-1815
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
16199
NV
2085R0202X
Diagnostic Radiology Physician
RTN9896
FL
2085R0202X
Diagnostic Radiology Physician
SP377
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
145U7
BCBS OF NC
NC
01
—
153000500
DOL
NC
01
—
219592
MEDCOST
NC
01
—
760158
MAMSI
NC
Enumeration date
05/15/2007
Last updated
12/07/2015
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