Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | X006538-1 | NY |
NPI | 1356390678 |
---|---|
Provider Name | Dr. Paul Edward Dougherty |
First Address | Rochester, NY 14620-4629 |
Second Address | Rochester, NY 14620-4629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
116580AN | PREFERRED CARE (01) | NY |
4415476 | AETNA (01) | NY |
CO6538-5 | WORK COMP (01) | NY |
U09800 | (02) | NY |