Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 740 | NC |
N | 222Z00000X | Podiatrist | 740 | NC |
Y | 213EP1101X | Primary Podiatric Medicine | 740 | NC |
N | 213ES0103X | Foot & Ankle Surgery | 740 | NC |
N | 213ES0131X | Foot Surgery | 740 | NC |
NPI | 1386616415 |
---|---|
Provider Name | Dr. Patrick Dougherty |
First Address | Raleigh, NC 27609-7325 |
Second Address | Raleigh, NC 27609-7325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 19/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6712460018 | MEDICARE NSC RALEIGH (01) | NC |
6712460024 | MEDICARE NSC HENDERSON (01) | NC |