Healthcare Provider Details

I. General information

NPI: 1760463442
Provider Name (Legal Business Name): DAVID J STROCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 S GILBERT RD STE 115
GILBERT AZ
85296-2262
US

IV. Provider business mailing address

PO BOX 1847
GILBERT AZ
85299-1847
US

V. Phone/Fax

Practice location:
  • Phone: 480-507-2961
  • Fax: 480-507-2971
Mailing address:
  • Phone: 480-507-2961
  • Fax: 480-507-2971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA82307
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number42198
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: