Healthcare Provider Details

I. General information

NPI: 1811125032
Provider Name (Legal Business Name): CHRISTOPHER D BOCK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 COLE ST
ENUMCLAW WA
98022-2638
US

IV. Provider business mailing address

1145 COLE ST
ENUMCLAW WA
98022-2638
US

V. Phone/Fax

Practice location:
  • Phone: 360-761-1285
  • Fax: 360-761-1313
Mailing address:
  • Phone: 360-761-1285
  • Fax: 360-761-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO60103083
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO60103083
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: