Healthcare Provider Details

I. General information

NPI: 1194239848
Provider Name (Legal Business Name): TYLER BOCK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COMMERCE WAY
CLOVIS NM
88101-4751
US

IV. Provider business mailing address

300 COMMERCE WAY
CLOVIS NM
88101-4751
US

V. Phone/Fax

Practice location:
  • Phone: 575-935-6262
  • Fax:
Mailing address:
  • Phone: 575-935-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: