Healthcare Provider Details

I. General information

NPI: 1013025923
Provider Name (Legal Business Name): ALAN STUART BOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 N PORTLAND SUITE 220
OKLAHOMA CITY OK
73112-2082
US

IV. Provider business mailing address

5401 N PORTLAND SUITE 220
OKLAHOMA CITY OK
73112-2082
US

V. Phone/Fax

Practice location:
  • Phone: 405-604-4321
  • Fax: 405-604-4331
Mailing address:
  • Phone: 405-604-4321
  • Fax: 405-604-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15266
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: