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General NPI Number Information
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NPI Number | 1427163609
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Entity Type | Individual
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Provider Name | CAROLYN MAUD DOHERTY M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 12/17/2013
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Provider Practice Location Address
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Address Line | 717 N 190TH PLZ SUITE # 2500
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City | ELKHORN
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State | NE
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Zip | 68022-3913
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Country | US
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Telephone | 402-815-1915
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Fax | 402-815-1065
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Provider Business Mailing Address
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Address Line | PO BOX 2797
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City | OMAHA
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State | NE
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Zip | 68103-2797
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Country | US
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Telephone | 402-354-4230
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Fax | 402-354-6171
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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 | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | 18934
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License Number State | NE
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