Individual
DR. RICHARD E DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3400 W TRUMAN BLVD, JEFFERSON CITY, MO 65109-5712
(573) 632-2777
(573) 632-2769
Mailing address
PO BOX 104780, JEFFERSON CITY, MO 65110-4780
(573) 632-0243
(573) 632-6900
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD115048
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203825906
—
MO
Enumeration date
06/16/2006
Last updated
12/29/2011
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