Provider Demographics
NPI:1205858917
Name:DOUGHERTY, DAVID CHARLES (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CHARLES
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3838 SAN DIMAS ST
Mailing Address - Street 2:SUITE A200
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2284
Mailing Address - Country:US
Mailing Address - Phone:661-654-0200
Mailing Address - Fax:661-664-2855
Practice Address - Street 1:3838 SAN DIMAS ST
Practice Address - Street 2:SUITE A200
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2284
Practice Address - Country:US
Practice Address - Phone:661-654-0200
Practice Address - Fax:661-664-2855
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG47681207R00000X, 207RA0201X, 207RC0000X, 207RC0200X, 207RE0101X, 207RG0100X, 207RG0300X, 207RH0003X, 207RI0008X, 207RI0200X, 207RN0300X, 207RP1001X, 207RR0500X, 207RS0010X, 207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG476810OtherMEDICAL
CAA50774Medicare UPIN
CAG476810OtherMEDICAL