Healthcare Provider Details

I. General information

NPI: 1497780209
Provider Name (Legal Business Name): DEVORAH ALANA CHOCK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 130TH ST SE FIRST FLOOR
EVERETT WA
98208
US

IV. Provider business mailing address

125 130TH ST SE FIRST FLOOR
EVERETT WA
98208
US

V. Phone/Fax

Practice location:
  • Phone: 425-385-2263
  • Fax: 425-385-8476
Mailing address:
  • Phone: 425-385-2263
  • Fax: 425-385-8476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA65092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: