Provider Demographics
NPI:1356458723
Name:MOCHE, GERVAIS PATRICK CHOKOTE (MD)
Entity Type:Individual
Prefix:
First Name:GERVAIS PATRICK
Middle Name:CHOKOTE
Last Name:MOCHE
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 1:870 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3291
Mailing Address - Country:US
Mailing Address - Phone:651-326-5650
Mailing Address - Fax:651-326-5671
Practice Address - Street 1:870 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3291
Practice Address - Country:US
Practice Address - Phone:651-326-5650
Practice Address - Fax:651-326-5671
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48709207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine