Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 4301057543 | MI |
Y | 207PE0004X | Emergency Medical Services | G157533 | CA |
NPI | 1043258544 |
---|---|
Provider Name | Dr. Dree Daugherty |
First Address | Santa Barbara, CA 93160-2106 |
Second Address | Santa Barbara, CA 93110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 27/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104266861 | (05) | MI |
DD057543 | BC/BS (01) | MI |
F77127 | (02) | MI |
G157533 | MEDICAL LICENSE (01) | CA |