Individual
THOMAS MICHAEL DOUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15627 IMPERIAL HWY, LA MIRADA, CA 90638-1627
(714) 990-0911
(714) 256-9172
Mailing address
15627 IMPERIAL HWY, LA MIRADA, CA 90638-1627
(714) 990-0911
(714) 256-9172
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
G27977
CA
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
G27977
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G279770
BLUE SHIELD ID #
—
05
—
00G279770
—
CA
01
—
023927
HEALTH NET ID #
—
01
—
110060919
RAILROAD
—
Enumeration date
06/01/2006
Last updated
03/30/2015
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