Healthcare Provider Details

I. General information

NPI: 1699792663
Provider Name (Legal Business Name): JUSTIN P QUOCK M.D., F.A.C.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 CLAY ST STE 207
SAN FRANCISCO CA
94108-1569
US

IV. Provider business mailing address

929 CLAY ST STE 207
SAN FRANCISCO CA
94108-1569
US

V. Phone/Fax

Practice location:
  • Phone: 415-398-5100
  • Fax: 415-837-1408
Mailing address:
  • Phone: 415-398-5100
  • Fax: 415-837-1408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberA55916
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA55916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: