Provider Demographics
NPI:1164044384
Name:BOCKHORST, SAMUEL PAUL (MD MEDICAL STUDENT)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:PAUL
Last Name:BOCKHORST
Suffix:
Gender:M
Credentials:MD MEDICAL STUDENT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:550 S JACKSON ST FL STREET3
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1622
Mailing Address - Country:US
Mailing Address - Phone:502-852-5666
Mailing Address - Fax:
Practice Address - Street 1:500 S PRESTON ST RM 305
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1702
Practice Address - Country:US
Practice Address - Phone:502-852-8696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program