MEDICARE: PAUL J DOUGHERTY M D INC

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	207W00000X	Ophthalmology Physician	G70688	CA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649203639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL J DOUGHERTY M D INC

Provider Business Mailing Address
First Line	:	4353 PARK TERRACE DR STE 150
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-4631
Country	:	US
Telephone Number	:	805-987-5300
Fax Number	:	818-707-7668

Provider Business Practice Location Address
First Line	:	4353 PARK TERRACE DR STE 150
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-4631
Country	:	US
Telephone Number	:	805-987-5300
Fax Number	:	818-707-7668

Authorized Official
Title or Position	:	CHIEF REVENUE OFFICER
Name	:	CLIFTON CHAD BAZHAW
Credential	:
Telephone Number	:	214-893-0471

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	03/02/2026

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