Individual
MR. TIMOTHY C DOUGHTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1141 ROSE AVENUE, SELMA, CA 93662-2640
(559) 891-1000
Mailing address
2420 HOWARD ST, KINGSBURG, CA 93613-2733
(816) 585-1850
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
145155
MO
367500000X
Certified Registered Nurse Anesthetist
145155
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
NA3913
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200305650A
—
KS
05
—
919046300
—
MO
Enumeration date
07/08/2006
Last updated
09/10/2019
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