Provider Demographics
NPI:1093991671
Name:GARY W DOCKS DPM PLLC
Entity Type:Organization
Organization Name:GARY W DOCKS DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:DOCKS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-646-5209
Mailing Address - Street 1:18810 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4014
Mailing Address - Country:US
Mailing Address - Phone:248-646-5209
Mailing Address - Fax:248-203-6927
Practice Address - Street 1:18810 BEVERLY RD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-4014
Practice Address - Country:US
Practice Address - Phone:248-646-5209
Practice Address - Fax:248-203-6927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGW000785213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIGD000785OtherLICENSE
MI4856312950OtherBCBSM
MI4856312950OtherBCBSM
MIT34217Medicare UPIN