Provider Demographics
NPI:1134653348
Name:DE KOCK, EDWIN ANDRE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:ANDRE
Last Name:DE KOCK
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 1:235 E. ROWAN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207
Mailing Address - Country:US
Mailing Address - Phone:530-953-7740
Mailing Address - Fax:
Practice Address - Street 1:235 E. ROWAN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207
Practice Address - Country:US
Practice Address - Phone:503-252-1905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD.MD.611246042083X0100X
390200000X
CA1608352083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program