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NPI Code Detail

MEDICARE: DR. JOHN THOMAS DAUGHERTY M.D.

MEDICARE: DR. JOHN THOMAS DAUGHERTY M.D.
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
1207Q00000XFamily Medicine PhysicianMD0000021373TN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2080030188OTHERTNRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1125762OTHERTNBLUE CROSS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306834122
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN THOMAS DAUGHERTY M.D.
Provider Business Mailing Address
First Line : 110 EXECUTIVE PARK DR
Second Line :
City : CLINTON
State : TN
Zip : 37716-6876
Country : US
Telephone Number : 865-494-9241
Fax Number : 865-494-2522
Provider Business Practice Location Address
First Line : 110 EXECUTIVE PARK DR
Second Line :
City : CLINTON
State : TN
Zip : 37716-6876
Country : US
Telephone Number : 865-494-9241
Fax Number : 865-494-2522
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2005
Last Update Date : 01/09/2009

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Directions to “ DR. JOHN THOMAS DAUGHERTY M.D.” Practice Location

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