Individual
ANDREW T DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3475 S ALPINE RD, ROCKFORD, IL 61109-2604
(815) 874-8000
Mailing address
713 SUNGLOW CT, DEKALB, IL 60115-8585
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.003763
IL
Other
Enumeration date
07/27/2010
Last updated
04/04/2016
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