Provider Demographics
NPI:1952013377
Name:DOCKERY, SEAN
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:DOCKERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-2291
Mailing Address - Country:US
Mailing Address - Phone:208-473-8301
Mailing Address - Fax:
Practice Address - Street 1:44 GARDEN LN
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-2291
Practice Address - Country:US
Practice Address - Phone:208-473-8301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker