Individual
DR. LISA L DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2367
(360) 414-2385
(360) 414-2386
Mailing address
PO BOX 3002, LONGVIEW, WA 98632-0302
(360) 414-2048
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD60132321
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0261154
LABOR & INDUSTRIES
WA
05
—
2006642
—
WA
05
—
500618521
—
OR
Enumeration date
07/06/2007
Last updated
11/03/2010
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