Healthcare Provider Details

I. General information

NPI: 1942308101
Provider Name (Legal Business Name): GREGORY P. MOCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 S POPLAR ST STE D
SEARCY AR
72143-6000
US

IV. Provider business mailing address

PO BOX 17930
LITTLE ROCK AR
72222-7930
US

V. Phone/Fax

Practice location:
  • Phone: 501-279-7077
  • Fax: 501-279-3970
Mailing address:
  • Phone: 501-663-0490
  • Fax: 501-663-5948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number20865
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberE8397
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: