Healthcare Provider Details

I. General information

NPI: 1497056873
Provider Name (Legal Business Name): THOMAS DOUGHERTY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 12/10/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12605 EAST FWY
HOUSTON TX
77015-5625
US

IV. Provider business mailing address

12605 EAST FWY
HOUSTON TX
77015-5625
US

V. Phone/Fax

Practice location:
  • Phone: 281-772-8557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: