MEDICARE: DR. JOEL FLOYD SCHOCK IV M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	29157	MN
2	207Q00000X	Family Medicine Physician	4892	ND

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00057347	OTHER	ND	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	068K7SC	OTHER	MN	MN BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	SCH23164	OTHER	ND	N DAKOTA BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790789576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL FLOYD SCHOCK IV M.D.

Provider Business Mailing Address
First Line	:	3290 20TH ST S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-5917
Country	:	US
Telephone Number	:	701-499-4800
Fax Number	:	701-451-9452

Provider Business Practice Location Address
First Line	:	3290 20TH ST S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-5917
Country	:	US
Telephone Number	:	701-499-4800
Fax Number	:	701-451-9452

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	10/15/2010

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Directions to “ DR. JOEL FLOYD SCHOCK IV M.D.” Practice Location

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