Provider Demographics
NPI:1174818884
Name:DAUGHERTY, JERROLD RAY (PA)
Entity type:Individual
Prefix:
First Name:JERROLD
Middle Name:RAY
Last Name:DAUGHERTY
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:36000 DARNALL LOOP
Mailing Address - Street 2:CARL R. DARNALL ARMY MEDICAL CENTER
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-4752
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36000 DARNALL LOOP
Practice Address - Street 2:CARL R. DARNALL ARMY MEDICAL CENTER
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-4752
Practice Address - Country:US
Practice Address - Phone:254-288-8025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant