MR. ROBERT LEE DOUGHERTY (NPI# 1891787529) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891787529 |
| Entity Type | Individual |
| Full Name | MR. ROBERT LEE DOUGHERTY |
| Credential | PA-C |
| Practice Address |
412 Nw 3rd St Casey IL 62420-1014 |
| Mailing Address |
4114 E Us 40 Casey IL 62420-3113 |
| Practice Telephone | 2179324061 |
| Practice Fax Number | 2179325191 |
| Mailing Telephone | 2173824754 |
| Mailing Fax Number | 2179325191 |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
085000498 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225239650 | Robert Lee Dougherty Jr. | Family Medicine | 13715 Poway Rd, Suite 1, Poway, CA 92064-4732 | 2007-05-31 |
| 1114935210 | Robert James Dougherty | Family Medicine | 441 Highway 71 W Ste B1, Bastrop, TX 78602-3937 | 2006-08-04 |
| 1154726362 | Robert N Dougherty | Physician Assistant | 520 Upper Chesapeake Dr, Suite 306, Bel Air, MD 21014-4339 | 2014-10-30 |
| 1932102241 | Robert P Dougherty | Internal Medicine | 111 Clara Barton St, Dansville, NY 14437 | 2005-05-31 |
| Street Address |
412 NW 3RD ST |
| City | CASEY |
| State | IL |
| Zip Code | 62420-1014 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609322296 | Champion Fitness, Inc | Clinic/Center | 1300 E. Us Highway 40, Casey, IL 62420 | 2016-09-01 |
| 1801089263 | Cory D Hanley | Physical Therapist | 1300 E Us Highway 40, Casey, IL 62420 | 2007-08-20 |
| 1528186665 | Sarah Bush Lincoln Health Center | Clinic/Center | 934 North Route 49, Casey, IL 62420 | 2007-03-27 |
| 1861499006 | Heartland Manor Inc Nursing Center | Skilled Nursing Facility | 410 N W Third Street, Casey, IL 62420 | 2005-07-01 |
| 1386124675 | Daniel Yi-li Wen | Dentist | 1400 E Main St, Casey, IL 62420 | 2018-08-16 |
| 1831228600 | Patrick M Niebrugge | Optometrist | 1279 E Us Hwy 40, Casey, IL 62420-0528 | 2007-03-05 |
| 1962696617 | Patrick Niebrugge Od | Durable Medical Equipment & Medical Supplies | 1279 E Us Hwy 40, Casey, IL 62420-0528 | 2007-09-05 |
| 1578036695 | Heartland Nursing & Rehabilitation LLC | Skilled Nursing Facility | 410 Nw 3rd St, Casey, IL 62420-1014 | 2019-01-11 |
| 1952874075 | Scott E Stout | Skilled Nursing Facility | 410 Nw 3rd St, Casey, IL 62420-1014 | 2019-01-11 |
| 1538166137 | Moore Family Stores Inc. | Pharmacy | 202 W Edgar Ave, Casey, IL 62420-1024 | 2005-06-28 |
| Find all providers in zip 62420 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831707298 | Eliza Ballen | Physician Assistant | 335 Sylvan Rd, Lake Bluff, IL 60044-2562 | 2020-07-21 |
| 1477177947 | Rybecca Janovyak | Physician Assistant | 14432 High Rd, Lockport, IL 60441-9402 | 2020-06-01 |
| 1518591759 | Julie Jenkot | Physician Assistant | 333 N Michigan Ave Fl 14, Chicago, IL 60601-3901 | 2020-02-26 |
| 1801429873 | Hinjal D Jha | Physician Assistant | 22285 N Pepper Rd Ste 409, Lake Barrington, IL 60010-2542 | 2020-02-19 |
| 1770120222 | Alvina Shaikh | Physician Assistant | 4009 Warren Ave, Bellwood, IL 60104-2066 | 2019-12-03 |
| 1457997561 | Jasleen Mohini Singh | Physician Assistant | 1645a W School Street, Suite A, Clinic Entrance, Chicago, IL 60657 | 2019-11-24 |
| 1538705272 | Bethany Mae Frisby | Physician Assistant | 8630 W Golf Rd, Niles, IL 60714-5600 | 2019-11-18 |
| 1134761984 | Ella-marie Rakowski | Physician Assistant | 25 Acorn Dr, Hawthorn Woods, IL 60047-7407 | 2019-10-14 |
| 1467001859 | Timothy Omotayo Adesanya | Physician Assistant | Graham Correctional Center, 12078 Illinois Rte 185, Hilliboro, IL 62049 | 2019-09-09 |
| 1518514066 | Victoria Moore | Physician Assistant | 979 W Main St, West Dundee, IL 60118-2088 | 2019-08-20 |
| Find all providers with the same taxonomy | ||||
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| 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.