Provider Demographics
NPI:1063458032
Name:MOCK, DAVID JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:MOCK
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:PO BOX 1719
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:NC
Mailing Address - Zip Code:28901-1719
Mailing Address - Country:US
Mailing Address - Phone:828-835-3111
Mailing Address - Fax:828-835-3592
Practice Address - Street 1:3765 E US HIGHWAY 64 ALT STE 9
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-6967
Practice Address - Country:US
Practice Address - Phone:828-835-3111
Practice Address - Fax:828-835-3592
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500412174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF98326Medicare UPIN