Healthcare Provider Details

I. General information

NPI: 1457396020
Provider Name (Legal Business Name): DR. SARSFIELD PATRICK DOUGHERTY
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 S RUSSELL ST
MISSOULA MT
59801-8536
US

IV. Provider business mailing address

1280 STARWOOD DR
MISSOULA MT
59808-9327
US

V. Phone/Fax

Practice location:
  • Phone: 406-721-4906
  • Fax:
Mailing address:
  • Phone: 406-721-7826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number6835
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: