Basic Information
| Provider Information | |||||||||
| NPI: | 1578523288 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOUGHERTY | ||||||||
| FirstName: | HUGH | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P O BOX 990 | ||||||||
| Address2: | 102 W 18TH ST | ||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422401911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707072100 | ||||||||
| FaxNumber: | 2707072103 | ||||||||
| Practice Location | |||||||||
| Address1: | 219 W 17TH ST | ||||||||
| Address2: | |||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422401911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708865141 | ||||||||
| FaxNumber: | 2708851877 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2006 | ||||||||
| LastUpdateDate: | 05/19/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 20877 | KY | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 64208770 | 05 | KY | MEDICAID |