Provider Demographics
NPI:1114347069
Name:DOCKERY, CRYSTAL A (DO)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:A
Last Name:DOCKERY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:A
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1599
Mailing Address - Country:US
Mailing Address - Phone:207-404-8200
Mailing Address - Fax:207-947-0435
Practice Address - Street 1:242 BRUNSWICK ST
Practice Address - Street 2:
Practice Address - City:OLD TOWN
Practice Address - State:ME
Practice Address - Zip Code:04468-1613
Practice Address - Country:US
Practice Address - Phone:207-827-6128
Practice Address - Fax:207-827-6605
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO2736207Q00000X
OK5732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine