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Individual

MISS CARIN DOUGHERTY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
601 W SPRUCE ST, SUITE C, MISSOULA, MT 59802-4057
(406) 329-5746
(406) 327-1697
Mailing address
601 W SPRUCE ST, SUITE C, MISSOULA, MT 59802-4057
(406) 329-5746
(406) 327-1697

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
19670
CA
363AM0700X
Medical Physician Assistant
Primary
MED-PAC-LIC-24421
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
M000009936
MEDICARE PTAN
MT
Enumeration date
10/17/2008
Last updated
06/21/2013
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