Provider Demographics
NPI:1073551586
Name:BOCK, HANS-GEORG OTTO (MD)
Entity Type:Individual
Prefix:DR
First Name:HANS-GEORG
Middle Name:OTTO
Last Name:BOCK
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 1:2500 N STATE ST
Mailing Address - Street 2:DEPARTMENT OF PREVENTIVE MEDICINE
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-1900
Mailing Address - Fax:601-984-1916
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:DEPARTMENT OF PREVENTIVE MEDICINE
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-1900
Practice Address - Fax:601-984-1916
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10089207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014153Medicaid
MS09014153Medicaid