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General NPI Number Information
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NPI Number | 1154423994
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Entity Type | Individual
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Provider Name | EDWARD CHOCK M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 09/10/2014
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Provider Practice Location Address
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Address Line | 1390 W H ST STE B
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City | OAKDALE
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State | CA
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Zip | 95361-3529
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Country | US
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Telephone | 209-847-2201
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Fax |
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Provider Business Mailing Address
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Address Line | 1390 W H ST STE B
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City | OAKDALE
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State | CA
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Zip | 95361-3570
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Country | US
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Telephone | 209-847-2201
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Fax | 209-847-0975
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G37486
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License Number State | CA
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