MEDICARE: JEFFREY S BOCK MD

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	207Q00000X	Family Medicine Physician	3787	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649274481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY S BOCK MD

Provider Business Mailing Address
First Line	:	PO BOX 1460
Second Line	:
City	:	ABERDEEN
State	:	SD
Zip	:	57402-1460
Country	:	US
Telephone Number	:	605-225-0378
Fax Number	:	605-225-7919

Provider Business Practice Location Address
First Line	:	105 S STATE ST
Second Line	:	SUITE 113
City	:	ABERDEEN
State	:	SD
Zip	:	57401-4500
Country	:	US
Telephone Number	:	605-225-0378
Fax Number	:	605-225-7919

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	09/02/2009

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Directions to “ JEFFREY S BOCK MD” Practice Location

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