Provider Demographics
NPI:1487941472
Name:DOUGHERTY, CHRISTOPHER KEITH (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:KEITH
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:211 SAINT FRANCIS DRIVE
Mailing Address - Street 2:MEDICAL AFFAIRS
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5049
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:211 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5049
Practice Address - Country:US
Practice Address - Phone:573-331-3000
Practice Address - Fax:573-331-5079
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP20048178207R00000X
MO2019036147207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine