Provider Demographics
NPI:1528333770
Name:DOHERTY, DAVID BOOTY JR
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BOOTY
Last Name:DOHERTY
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 1:6400 FANNIN ST STE 1700
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1526
Mailing Address - Country:US
Mailing Address - Phone:713-486-7500
Mailing Address - Fax:713-512-2234
Practice Address - Street 1:5420 WEST LOOP S STE 2400
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2118
Practice Address - Country:US
Practice Address - Phone:713-486-3550
Practice Address - Fax:713-314-2990
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS0278207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery