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General NPI Number Information
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NPI Number | 1609389097
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Entity Type | Individual
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Provider Name | JOHN CHARLES BOCKMANN PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 11/08/2017
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Last Update Date | 11/08/2017
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Provider Practice Location Address
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Address Line | CONNOR TROOP MEDICAL CLINIC 10506 EUPHRATES RIVER VALLEY RD
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City | FORT DRUM
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State | NY
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Zip | 13602
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Country | US
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Telephone | 615-974-2093
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Fax |
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Provider Business Mailing Address
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Address Line | 11766A ORCHARD DR
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City | FORT DRUM
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State | NY
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Zip | 13603-3126
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Country | US
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Telephone | 615-974-2093
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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