Provider Demographics
NPI:1659048718
Name:DOCKERY, HUSTON (PA-C)
Entity Type:Individual
Prefix:
First Name:HUSTON
Middle Name:
Last Name:DOCKERY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 HOSPITAL DR STE 265
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1981
Mailing Address - Country:US
Mailing Address - Phone:513-732-9300
Mailing Address - Fax:513-732-5663
Practice Address - Street 1:2055 HOSPITAL DR STE 300
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1981
Practice Address - Country:US
Practice Address - Phone:513-732-0663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.007007363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant