Provider Demographics
NPI:1073659041
Name:DOCK, ERVIN W (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:ERVIN
Middle Name:W
Last Name:DOCK
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 E REPUBLIC RD
Mailing Address - Street 2:BLDG E 200
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-6008
Mailing Address - Country:US
Mailing Address - Phone:417-886-1960
Mailing Address - Fax:417-886-2302
Practice Address - Street 1:909 E REPUBLIC RD
Practice Address - Street 2:BLDG E 200
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-6008
Practice Address - Country:US
Practice Address - Phone:417-886-1960
Practice Address - Fax:417-886-2302
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO200237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist