Provider Demographics
NPI:1669433231
Name:DOCKERY, DOUGLAS STEWART (DPM)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:STEWART
Last Name:DOCKERY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 JANETTE AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4816
Mailing Address - Country:US
Mailing Address - Phone:540-632-5053
Mailing Address - Fax:
Practice Address - Street 1:401 ROGERS ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-3636
Practice Address - Country:US
Practice Address - Phone:304-487-9442
Practice Address - Fax:330-536-0069
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301043213E00000X
WV10428213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist