| Daugherty And Daugherty Medical Clinic Pa | |
|
1409 Braden St Jacksonville AR 72076-3720 | |
| (501) 982-0576 | |
| (501) 982-0041 |
| Full Name | Daugherty And Daugherty Medical Clinic Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 1409 Braden St, Jacksonville, Arkansas |
| Authorized Official Name and Position | Joe D Daugherty (PRESIDENT) |
| Authorized Official Contact | 5019820576 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Daugherty And Daugherty Medical Clinic Pa 1409 West Braden Jacksonville AR 72076 Ph: (501) 982-0576 | Daugherty And Daugherty Medical Clinic Pa 1409 Braden St Jacksonville AR 72076-3720 Ph: (501) 982-0576 |
| NPI Number | 1942268123 |
|---|---|
| Provider Enumeration Date | 05/03/2006 |
| Last Update Date | 02/07/2020 |
| Medicare PECOS PAC ID | 8628237161 |
|---|---|
| Medicare Enrollment ID | O20120302000130 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942268123 | NPI | - | NPPES |
| 04D0466369 | Other | AR | CLIA |
| 104806002 | Medicaid | AR | |
| CS4952 | Other | RR MCR CLINIC # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | John L Daugherty |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1124076922 PECOS PAC ID: 6204814130 Enrollment ID: I20040708000705 |
| Provider Name | Joe D Daugherty |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912965187 PECOS PAC ID: 0648258434 Enrollment ID: I20040708001230 |
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