Healthcare Provider Details

I. General information

NPI: 1912925470
Provider Name (Legal Business Name): ANNE H DOUGHERTY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 FANNIN ST 600
HOUSTON TX
77030-3000
US

IV. Provider business mailing address

PO BOX 301173
DALLAS TX
75303-1173
US

V. Phone/Fax

Practice location:
  • Phone: 832-325-7211
  • Fax:
Mailing address:
  • Phone: 713-500-3500
  • Fax: 713-512-2245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG1241
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG1241
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberG1241
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: