Provider Demographics
NPI:1336125715
Name:BOCKRATH, JODY M (MD)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:M
Last Name:BOCKRATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JODY
Other - Middle Name:M
Other - Last Name:WEINSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:27101 SE 166TH PL
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-6911
Mailing Address - Country:US
Mailing Address - Phone:360-202-7893
Mailing Address - Fax:
Practice Address - Street 1:1716 W. MARINE VIEW DRIVE #C
Practice Address - Street 2:NORTH SOUND EMERGENCY MEDICINE
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201
Practice Address - Country:US
Practice Address - Phone:425-259-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 60141982207P00000X
AL000255582083A0100X
NY62665390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program