Individual
MR. ROBERT LEE DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
412 NW 3RD ST, CASEY, IL 62420-1014
(217) 932-4061
(217) 932-5191
Mailing address
4114 E US 40, CASEY, IL 62420-3113
(217) 382-4754
(217) 932-5191
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085000498
IL
Other
Enumeration date
08/18/2005
Last updated
07/09/2007
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