MEDICARE: DR. TIM DOCKMAN D.O.

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	208D00000X	General Practice Physician	18587	CA

General Provider Information

NPI Number	:	1992090088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIM DOCKMAN D.O.

Provider Business Mailing Address
First Line	:	2533 PLEASURE HOUSE RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-1359
Country	:	US
Telephone Number	:	619-865-6893
Fax Number	:

Provider Business Practice Location Address
First Line	:	2533 PLEASURE HOUSE RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-1359
Country	:	US
Telephone Number	:	619-865-6893
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	08/26/2022

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