Active NPI
James J Dougherty, MD
- Aerospace Medicine Physician
- Canyon Lake, TX
National Provider Identifier
1295760544
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Aerospace Medicine Physician
- License
- E4302
- Practice address
- 2454 Island VW
Canyon Lake, TX 78133-5144 - Phone
- (830) 899-7064
- NPI assigned
- Jul 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Aerospace Medicine Physician | 2083A0100X | E4302 | TX | Primary |
Addresses
Primary practice location
2454 Island VW
Canyon Lake, TX 78133-5144
Mailing address
2454 Island VW
Canyon Lake, TX 78133-5144
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E4302 | TX | MD | Aerospace Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343001600000",
"number": "1295760544",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2454 ISLAND VW",
"city": "CANYON LAKE",
"state": "TX",
"postal_code": "781335144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2454 ISLAND VW",
"city": "CANYON LAKE",
"state": "TX",
"postal_code": "781335144",
"telephone_number": "830-899-7064"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGHERTY",
"first_name": "JAMES",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-12",
"last_updated": "2012-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "2083A0100X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Aerospace Medicine",
"state": "TX",
"license": "E4302",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canyon Lake, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.