MEDICARE: DR. MATTHEW JAMES DOUGHERTY DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	PO4344	FL
2	213ES0103X	Foot & Ankle Surgery Podiatrist	PO4344	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255822599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW JAMES DOUGHERTY DPM

Provider Business Mailing Address
First Line	:	26827 FOGGY CREEK RD STE 104
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-6768
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 7TH ST W
Second Line	:
City	:	PALMETTO
State	:	FL
Zip	:	34221-5209
Country	:	US
Telephone Number	:	941-776-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2018
Last Update Date	:	11/15/2024

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