MEDICARE: PATRICK J DOUGHERTY PA C

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
1	363A00000X	Physician Assistant	5601003937	MI

General Provider Information

NPI Number	:	1285625590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK J DOUGHERTY PA C

Provider Business Mailing Address
First Line	:	9331 S COLORADO BLVD
Second Line	:	SUITE 200
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80126-7467
Country	:	US
Telephone Number	:	303-471-4711
Fax Number	:	303-471-4767

Provider Business Practice Location Address
First Line	:	9331 S COLORADO BLVD
Second Line	:	SUITE 200
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80126-7467
Country	:	US
Telephone Number	:	303-471-4711
Fax Number	:	303-471-4767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	11/23/2020

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