MEDICARE: KARL T. DOCKRAY, M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	C8947	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1790798817	OTHER	TX	NPI TYPE 1

General Provider Information

NPI Number	:	1396934626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KARL T. DOCKRAY, M.D., P.A.

Provider Business Mailing Address
First Line	:	1808 19TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79401-4811
Country	:	US
Telephone Number	:	806-763-5774
Fax Number	:

Provider Business Practice Location Address
First Line	:	1808 19TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79401-4811
Country	:	US
Telephone Number	:	806-763-5774
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KARL T. DOCKRAY
Credential	:	M.D.
Telephone Number	:	806-763-5774

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	10/23/2007

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