Provider Demographics
NPI:1538471727
Name:DAUGHERTY, HEATHER M (MD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:M
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:D
Other - Last Name:MUNDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1626 OCONNELL BLVD
Mailing Address - Street 2:
Mailing Address - City:FT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4060
Mailing Address - Country:US
Mailing Address - Phone:719-524-7351
Mailing Address - Fax:
Practice Address - Street 1:1626 OCONNELL BLVD
Practice Address - Street 2:
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4060
Practice Address - Country:US
Practice Address - Phone:719-524-7351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-05
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116022753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine