Provider Demographics
NPI:1093770554
Name:DOCKRAY, LEE R (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:R
Last Name:DOCKRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6210 E HIGHWAY 290
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1142
Mailing Address - Country:US
Mailing Address - Phone:512-483-9596
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:901 CRYSTAL FALLS PKWY STE 103
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-1931
Practice Address - Country:US
Practice Address - Phone:512-259-2198
Practice Address - Fax:512-406-7374
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG4989208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE79491Medicare UPIN