Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 0101267145 | VA |
NPI | 1174968440 |
---|---|
Provider Name | William M Dougherty |
First Address | Norfolk, VA 23501-0936 |
Second Address | Norfolk, VA 23507-1904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2013 |
Last Update Date | 27/06/2019 |