Healthcare Provider Details

I. General information

NPI: 1699779454
Provider Name (Legal Business Name): MARTINA DOCKERY MONROE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTINA L DOCKERY-BENFIELD MD

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 S MAIN ST
RAEFORD NC
28376-3222
US

IV. Provider business mailing address

405 S MAIN ST
RAEFORD NC
28376-3222
US

V. Phone/Fax

Practice location:
  • Phone: 910-609-5800
  • Fax: 910-875-0309
Mailing address:
  • Phone: 910-609-5800
  • Fax: 910-875-0309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8901239
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: