Healthcare Provider Details

I. General information

NPI: 1386685188
Provider Name (Legal Business Name): CURTIS MOCK
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 KELTON ST
REHOBOTH MA
02769-2530
US

IV. Provider business mailing address

23 KELTON ST
REHOBOTH MA
02769-2530
US

V. Phone/Fax

Practice location:
  • Phone: 508-252-6075
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number159294
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: