Individual
MATTHEW DAVID DOUGHMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1711 27TH ST STE 102, PORTSMOUTH, OH 45662-2657
(740) 356-1709
(740) 353-3027
Mailing address
1735 27TH ST STE B06, PORTSMOUTH, OH 45662-2681
(740) 356-6942
(740) 356-7851
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
50.003770RX
OH
363AM0700X
Medical Physician Assistant
PA1706
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0086440
—
OH
01
—
1103317
NCCPA
—
05
—
7100219770
—
KY
01
—
PA1706
KENTUCKY MEDICAL BOARD
KY
01
—
TC091
KENTUCKY MEDICAL BOARD
KY
Enumeration date
01/07/2011
Last updated
12/22/2020
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