Provider Demographics
NPI:1053499624
Name:MOCKLER, RAYMOND A (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:A
Last Name:MOCKLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4011
Mailing Address - Country:US
Mailing Address - Phone:850-769-7270
Mailing Address - Fax:850-769-7229
Practice Address - Street 1:500 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4011
Practice Address - Country:US
Practice Address - Phone:850-769-7270
Practice Address - Fax:850-769-7229
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME679032086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27145OtherBCBS
FLF82448Medicare UPIN
FL27145AMedicare ID - Type Unspecified