Provider Demographics
NPI:1396934626
Name:KARL T. DOCKRAY, M.D., P.A.
Entity type:Organization
Organization Name:KARL T. DOCKRAY, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:T
Authorized Official - Last Name:DOCKRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-763-5774
Mailing Address - Street 1:1808 19TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-4811
Mailing Address - Country:US
Mailing Address - Phone:806-763-5774
Mailing Address - Fax:
Practice Address - Street 1:1808 19TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-4811
Practice Address - Country:US
Practice Address - Phone:806-763-5774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC89472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1790798817OtherNPI TYPE 1
TXE07955Medicare UPIN
TX00K312Medicare Oscar/Certification