Healthcare Provider Details

I. General information

NPI: 1104848241
Provider Name (Legal Business Name): MARTIN A DOCHERTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VETERANS AVE
BILOXI MS
39531-2410
US

IV. Provider business mailing address

660 S EUCLID AVE CB 8072
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 228-523-8336
  • Fax:
Mailing address:
  • Phone: 314-747-3000
  • Fax: 314-747-4876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR8N60
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: