Provider Demographics
NPI:1457436735
Name:DOCK, JOHN (MSCCCA-A)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:DOCK
Suffix:
Gender:M
Credentials:MSCCCA-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-9007
Mailing Address - Country:US
Mailing Address - Phone:417-875-3000
Mailing Address - Fax:
Practice Address - Street 1:960 E WALNUT LAWN ST
Practice Address - Street 2:FERRELL DUNCAN CLINIC ENT
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7506
Practice Address - Country:US
Practice Address - Phone:417-875-3600
Practice Address - Fax:417-875-3625
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113808174400000X, 231H00000X
MO001241237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No174400000XOther Service ProvidersSpecialist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1457436735Medicaid