1134565872 NPI number — DAVID J. MOCK, MD, PA

Table of content: (NPI 1134565872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134565872 NPI number — DAVID J. MOCK, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID J. MOCK, MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134565872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1719
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDREWS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28901-1719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3765 E HWY 64 ALT
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
MURPHY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-835-3111
Provider Business Practice Location Address Fax Number:
828-835-3592
Provider Enumeration Date:
05/21/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MOCK
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
MD/PRESIDENT
Authorized Official Telephone Number:
828-835-3111

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com