Dougherty, Thomas Michael

Dougherty, Thomas Michael is an sole proprietor health care provider with primary practice located at 15627 Imperial Hwy , La Mirada CA 90638-1627. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Cardiovascular Disease, Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism. Allopathic & Osteopathic Physicians / Cardiovascular Disease is his primary health care specialty. Dougherty, Thomas Michael can be contacted via phone (714) 990-0911.

Contact Information

Primary practice address
15627 Imperial Hwy La Mirada CA 90638-1627
Phone: (714) 990-0911
Fax: (714) 256-9172
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X G27977 California
Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism 207RE0101X G27977 California

Profile Details

NPI number 1699712232
LBN Legal business name Dougherty, Thomas Michael
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 1st, 2006
Last updated Mar 30th, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699712232 NPPES
Other 00G279770 BLUE SHIELD ID #
Other 023927 BLUE SHIELD ID #
MEDICAID 00G279770 BLUE SHIELD ID #
Other 110060919 BLUE SHIELD ID #

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