Provider Demographics
NPI:1730686262
Name:DOCKERY, LISA ISHII (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ISHII
Last Name:DOCKERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2543 MERIDIAN PKWY APT 6318
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4229
Mailing Address - Country:US
Mailing Address - Phone:404-693-0652
Mailing Address - Fax:
Practice Address - Street 1:5821 FARRINGTON RD STE 101
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-9901
Practice Address - Country:US
Practice Address - Phone:919-403-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-02321207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology