Individual
DR. FOREST DALE DAUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4041 SHOSHONEE DR, COLUMBUS, IN 47203-2531
(812) 372-5688
Mailing address
4041 SHOSHONEE DR, COLUMBUS, IN 47203-2531
(812) 372-5688
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
010118019
IN
Other
Enumeration date
03/01/2011
Last updated
03/01/2011
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