Individual
DR. KEVIN GLEN DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6511 TAGGART RD, DELAWARE, OH 43015-8893
(740) 548-6180
(740) 548-1882
Mailing address
6511 TAGGART RD, DELAWARE, OH 43015-8893
(740) 548-6180
(740) 548-1882
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
34005332
OH
207Q00000X
Family Medicine Physician
34.005332
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000319608
BCBS GREENFIELD
—
01
—
000000591796
BCBS FAYETTE
OH
05
—
0861367
—
OH
Enumeration date
09/02/2006
Last updated
05/31/2024
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