Provider Demographics
NPI:1043252844
Name:DOUGHERTY, JOHN D III (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:DOUGHERTY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E. VUELTA CAMINATA DEL RIO
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737
Mailing Address - Country:US
Mailing Address - Phone:520-547-5688
Mailing Address - Fax:520-547-4661
Practice Address - Street 1:555 E. VUELTA CAMINATA DEL RIO
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737
Practice Address - Country:US
Practice Address - Phone:520-547-5688
Practice Address - Fax:520-547-4661
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41024207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ139672OtherPTAN
AZZ139672OtherPTAN