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General NPI Number Information
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NPI Number | 1245510932
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Entity Type | Individual
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Provider Name | MATTHEW DAVID DAUGHERTY DPM
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Gender | Male
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Dates
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Enumeration Date | 08/25/2011
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Last Update Date | 03/06/2015
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Provider Practice Location Address
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Address Line | 3316 N UNIVERSITY DR
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City | NACOGDOCHES
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State | TX
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Zip | 75965-2632
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Country | US
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Telephone | 936-559-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 200 S JOHN REDDITT DR
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City | LUFKIN
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State | TX
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Zip | 75904-3112
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Country | US
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Telephone | 936-559-1700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PDT-519
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License Number State | CO
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