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General NPI Number Information
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NPI Number | 1255564787
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Entity Type | Individual
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Provider Name | DENE WESLEY DAUGHERTY D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/01/2009
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 2656 EDITH AVE
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City | REDDING
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State | CA
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Zip | 96001-3030
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Country | US
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Telephone | 530-244-2882
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Fax | 530-244-3703
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Provider Business Mailing Address
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Address Line | 3400 DATA DR ATTENTION: CREDENTIALING AND PAYER ENROLLMENT DEPT
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670
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Country | US
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Telephone |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 24362
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License Number State | CA
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