Robert Lee Dougherty, PA-C
Individual provider Active NPI Medical Physician Assistant · Casey, IL
NPI 1891787529 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1891787529
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 085000498 (IL)
- Practice address
- 412 NW 3Rd St
Casey, IL 62420-1014 - Phone
- (217) 932-4061
- Fax
- (217) 932-5191
- NPI assigned
- Aug 18, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sarah Bush Lincoln Health Center | Past | Accepting new patients | |
| Sarah Bush Lincoln Health Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 085000498 | IL | Yes |
Addresses
Primary practice location
412 NW 3Rd St
Casey, IL 62420-1014
Mailing address
4114 E US 40
Casey, IL 62420-3113
Phone (217) 382-4754
Other providers in Casey, IL
- Champion Fitness, Inc
- Clark Cochonour
- Gena Cochonour
- Lyn Michele Cochonour
- Katherine Disch
- Kristi Esker
- Makenzie Alicen Goble
- Cory D Hanley
- Heartland Manor Inc Nursing Center
- Heartland Nursing & Rehabilitation LLC
All providers in Casey, IL · Medical Physician Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.