Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 0427658 | KS |
N | 207Q00000X | Family Doctor | M3427 | ID |
NPI | 1124086384 |
---|---|
Provider Name | Dr. Daniel W Doherty |
First Address | Liberal, KS 67901 |
Second Address | Liberal, KS 67905-1340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 15/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100320390B | (05) | KS |
A11145 | (02) | KS |