Basic Information
| Provider Information | |||||||||
| NPI: | 1407916190 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOUGHERTY | ||||||||
| FirstName: | MINNIE | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | COMMANDER USA MEDDAC AK MCUC MMD ATTN CREDENTIALS | ||||||||
| Address2: | 1060 GAFFNEY RD STE 7440 | ||||||||
| City: | FT WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997037440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073535418 | ||||||||
| FaxNumber: | 9073534847 | ||||||||
| Practice Location | |||||||||
| Address1: | COMMANDER USA MEDDAC AK MCUC MMD ATTN CREDENTIALS | ||||||||
| Address2: | 1060 GAFFNEY RD STE 7440 | ||||||||
| City: | FT WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997037440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073535418 | ||||||||
| FaxNumber: | 9073534847 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.