Healthcare Provider Details

I. General information

NPI: 1649255332
Provider Name (Legal Business Name): SARA ELLEN DOUGHERTY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7420 GREENHAVEN DRIVE SUITE 130
SACRAMENTO CA
95831
US

IV. Provider business mailing address

7420 GREENHAVEN DRIVE SUITE 130
SACRAMENTO CA
95831
US

V. Phone/Fax

Practice location:
  • Phone: 916-399-6015
  • Fax: 916-394-3344
Mailing address:
  • Phone: 916-399-6015
  • Fax: 916-394-3344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA69860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: