Provider Demographics
NPI:1205845823
Name:HOCKIN, BENJAMIN J (DPM)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:J
Last Name:HOCKIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8019 LAVA REACH AVE NW
Mailing Address - Street 2:STE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-6531
Mailing Address - Country:US
Mailing Address - Phone:505-210-2113
Mailing Address - Fax:505-962-0701
Practice Address - Street 1:8019 LAVA REACH AVE NW STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-6531
Practice Address - Country:US
Practice Address - Phone:505-210-2113
Practice Address - Fax:505-962-0701
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM393213E00000X
MT135213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0390592Medicaid
MT000018311OtherBCBS
MT000018311OtherBCBS
MT0390592Medicaid