DAVID ALAN DAUGHERTY (NPI# 1689648214) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689648214 |
| Entity Type | Individual |
| Full Name | DAVID ALAN DAUGHERTY |
| Credential | PA-C |
| Practice Address |
7601 W Jefferson Blvd Fort Wayne IN 46804-4133 |
| Mailing Address |
Po Box 2526 Fort Wayne IN 46801-2526 |
| Practice Telephone | 2604368686 |
| Practice Fax Number | 2604368585 |
| Mailing Telephone | 2604368686 |
| Mailing Fax Number | 2604368585 |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2016-11-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
10001118A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
50-002861 | OH | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | NCCPA | 1084497 | 01 |
| RAILROAD MEDICARE | P00877355 | 01 | |
| IN | ANTHEM | 000000626650 | 01 |
| IN | OPR | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477677078 | David Shoff Daugherty | Dentist | 9660 Rt #19, Houghton, NY 14744-0037 | 2007-03-19 |
| 1679575344 | David Lee Daugherty | Orthopaedic Surgery | 3905 Waring Rd, Oceanside, CA 92056-4405 | 2005-08-12 |
| 1225402647 | David Daugherty | Marriage & Family Therapist | 1903 Island Walk Way, Fernandina Beach, FL 32034-4797 | 2015-11-23 |
| 1457621021 | David Daugherty | Pharmacist | 6314 N 9th Ave, Pensacola, FL 32504-7320 | 2012-01-12 |
| 1780691584 | David D Daugherty | Dentist | 5104 S Field St, Unit A, Littleton, CO 80123-7308 | 2006-08-02 |
| 1295711604 | David R Daugherty | Psychiatry & Neurology | 200 1st St Sw, Rochester, MN 55905-0001 | 2005-12-16 |
| Street Address |
7601 W JEFFERSON BLVD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804-4133 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497758429 | Fort Wayne Orthopaedics LLC | Orthopaedic Surgery | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2005-05-23 |
| 1801456553 | Elizabeth Schaefer | Specialist/Technologist | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2019-06-15 |
| 1417514480 | Courtney Mangan | Nurse Practitioner | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2019-05-24 |
| 1881177798 | Lindsey M. Hertenstein | Registered Nurse | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2018-09-07 |
| 1912407099 | Heather Korte | Registered Nurse | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2018-02-15 |
| 1902314958 | John Grimshaw | Registered Nurse | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2018-01-11 |
| 1053836882 | Alex Villavicencio | Nurse Practitioner | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2017-08-14 |
| 1841721735 | Abbey K. Bunnell | Nurse Practitioner | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2017-03-23 |
| 1093256950 | Jessica A. Wiedemann | Nurse Practitioner | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2017-03-13 |
| 1245786672 | Abigail Vanlaningham | Physician Assistant | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2016-08-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265860589 | Thomas Meehan | Physician Assistant | 11108 Parkview Circle Dr, Suite 5100, Fort Wayne, IN 46845-1730 | 2013-10-23 |
| 1578648259 | Nicole Grace Curl | Physician Assistant | 5050 N Clinton St, Fort Wayne, IN 46825-5886 | 2006-10-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386289957 | Jordan Nickley Nemer | Physician Assistant | 270 E Day Rd Ste 200, Mishawaka, IN 46545-3444 | 2019-11-07 |
| 1760947329 | Ellen M Randall | Physician Assistant | 705 Riley Hospital Dr Ste 2514, Indianapolis, IN 46202-5109 | 2019-02-07 |
| 1710459839 | Alyssa Tripp | Physician Assistant | 1007 Lincolnway Rm 1107, La Porte, IN 46350-3201 | 2018-12-31 |
| 1992283899 | Kelsey Arnold | Physician Assistant | 275 W Bassett Rd Ste 2, Shelbyville, IN 46176-8575 | 2018-08-02 |
| 1396249926 | Deaconess Specialty Physicians, Inc | Physician Assistant | 1813 Willow St Ste 5a, Vincennes, IN 47591-4279 | 2018-03-20 |
| 1477924892 | Kristen Marie Ness | Physician Assistant | 13100 E 136th St Ste 2000, Fishers, IN 46037-9440 | 2015-10-12 |
| 1982945960 | Heather Bunnell | Physician Assistant | 3943 Hay Market Dr, Jeffersonville, IN 47130-8260 | 2013-03-15 |
| 1255685772 | Jarron J Lincoln | Physician Assistant | 5230 E Stop 11 Rd Ste 250, Indianapolis, IN 46237 | 2012-11-06 |
| 1427364926 | Rebecca Lou Autry | Physician Assistant | 10081 Fredericksburg Rd Nw, Depauw, IN 47115-8629 | 2010-08-23 |
| 1558685495 | Douglas D Kesler | Physician Assistant | 1411 S Creasy Lane, Suite 120, Lafayette, IN 47905-7433 | 2010-03-22 |
| Find all providers with the same taxonomy | ||||
| City | FORT WAYNE |
| Zip Code | 46804 |
Please comment or provide details below to improve the information on DAVID ALAN DAUGHERTY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.