Individual
DAVID ALAN DAUGHERTY
Active
Individual
DAVID ALAN DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
10001118A
IN
363AS0400X
Surgical Physician Assistant
50-002861
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000626650
ANTHEM
IN
01
—
1084497
NCCPA
OH
05
—
OPR
—
IN
01
—
P00877355
RAILROAD MEDICARE
—
Enumeration date
02/13/2006
Last updated
11/07/2016
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