Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 4301083727 | MI |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 4301083727 | MI |
NPI | 1639382328 |
---|---|
Provider Name | Dr. Paul Joseph Dougherty |
First Address | Detroit, MI 48201-2153 |
Second Address | Detroit, MI 48201-2153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 24/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G80211 | (02) | MI |