Individual
MATTHEW DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13303 TESSON FERRY RD, SAINT LOUIS, MO 63128-4062
(314) 842-5239
(314) 842-3835
Mailing address
PO BOX 23340, SAINT LOUIS, MO 63156-3340
(314) 842-5239
(314) 842-3835
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A88589
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
219515
BCBS
—
01
—
2700164
UHC
—
01
—
319419
GHP
—
01
—
6305736
CIGNA
—
01
—
72299V34311
HEALTHCARE USA
MO
01
—
7373873
AETNA
—
Enumeration date
06/21/2006
Last updated
09/21/2012
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