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General NPI Number Information
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NPI Number | 1245735133
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Entity Type | Individual
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Provider Name | MICHAEL JAMES DOUGHERTY MD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2018
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Last Update Date | 09/07/2024
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Provider Practice Location Address
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Address Line | 450 E MERRITT ISLAND CSWY # 600
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-3503
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Country | US
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Telephone | 321-453-3638
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Fax |
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Provider Business Mailing Address
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Address Line | 3401 NORTH BLVD STE 200
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City | BATON ROUGE
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State | LA
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Zip | 70806-3743
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Country | US
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Telephone | 225-381-6620
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | ME148451
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License Number State | FL
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