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General NPI Number Information
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NPI Number | 1225227952
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Entity Type | Organization
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Legal Business Name | STEPHEN E. GOCKE M.D. INC.
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 1503 N IMPERIAL AVE SUITE 203
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City | EL CENTRO
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State | CA
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Zip | 92243-6301
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Country | US
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Telephone | 760-352-5067
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Fax | 760-352-9999
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Provider Business Mailing Address
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Address Line | PO BOX 417
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City | EL CENTRO
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State | CA
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Zip | 92244-0417
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Country | US
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Telephone | 760-352-5067
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Fax | 760-352-9999
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN EDMUND GOCKE
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Credential | M.D.
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Telephone | 760-352-5067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | G48685
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License Number State | CA
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