Provider Demographics
NPI:1093921249
Name:COLLIN P. QUOCK, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:COLLIN P. QUOCK, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:POY
Authorized Official - Last Name:QUOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-398-5100
Mailing Address - Street 1:929 CLAY ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-1556
Mailing Address - Country:US
Mailing Address - Phone:415-398-5100
Mailing Address - Fax:415-398-5102
Practice Address - Street 1:929 CLAY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1556
Practice Address - Country:US
Practice Address - Phone:415-398-5100
Practice Address - Fax:415-398-5102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA21619171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA21619OtherSTATE LICENSE NUMBER
CA00A216190Medicaid
CAA21619OtherSTATE LICENSE NUMBER
CA00A216190Medicaid