Healthcare Provider Details

I. General information

NPI: 1265672935
Provider Name (Legal Business Name): RAYMOND JAMES DOHERTY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 11/02/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984 W 66TH AVE
MERRILLVILLE IN
46410-3210
US

IV. Provider business mailing address

984 W 66TH AVE
MERRILLVILLE IN
46410-3210
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-2345
  • Fax:
Mailing address:
  • Phone: 219-769-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01016733B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: