Provider Demographics
NPI:1316482938
Name:DOUGHERTY, DONALD JOSEPH JR
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:JOSEPH
Last Name:DOUGHERTY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8411 PACIFIC HWY E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-3915
Mailing Address - Country:US
Mailing Address - Phone:253-926-8971
Mailing Address - Fax:253-926-2488
Practice Address - Street 1:8411 PACIFIC HWY E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-3915
Practice Address - Country:US
Practice Address - Phone:253-926-8971
Practice Address - Fax:253-926-2488
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies