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General NPI Number Information
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NPI Number | 1619991890
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Entity Type | Individual
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Provider Name | DANA LYNN DOUGHERTY MD
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Gender | Female
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 6400 DUTCHMANS PKWY STE.300
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City | LOUISVILLE
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State | KY
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Zip | 40205-3340
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Country | US
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Telephone | 502-894-2444
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Fax | 502-894-2445
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-6351
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Country | US
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Telephone | 502-558-9529
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Fax | 502-272-5339
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35-082494
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 46382
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License Number State | KY
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