Provider Demographics
NPI:1356313852
Name:SCHOCKER, JACK D (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:D
Last Name:SCHOCKER
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:PO BOX 687
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16603-0687
Mailing Address - Country:US
Mailing Address - Phone:814-889-2400
Mailing Address - Fax:814-889-2048
Practice Address - Street 1:620 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4804
Practice Address - Country:US
Practice Address - Phone:814-889-2400
Practice Address - Fax:814-889-2048
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020848E2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008766200004Medicaid
PA0008766200004Medicaid
PAB35830Medicare UPIN