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NPI Code Detail

MEDICARE: DR. STEPHEN WAYNE DAUGHERTY DMP

MEDICARE: DR. STEPHEN WAYNE DAUGHERTY DMP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0103XFoot & Ankle Surgery Podiatrist3078TX

General Provider Information

NPI Number : 1114451911
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHEN WAYNE DAUGHERTY DMP
Provider Business Mailing Address
First Line : 327 PATRIOT ST
Second Line :
City : KERRVILLE
State : TX
Zip : 78028-5821
Country : US
Telephone Number : 830-370-1200
Fax Number :
Provider Business Practice Location Address
First Line : 3600 MEMORIAL BLVD
Second Line :
City : KERRVILLE
State : TX
Zip : 78028-5819
Country : US
Telephone Number : 830-370-1200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2017
Last Update Date : 03/20/2022

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