Provider Demographics
NPI:1407879083
Name:MOCKLER, KAREN J (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:MOCKLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 SOUTH TALLASSEE STREET
Mailing Address - Street 2:
Mailing Address - City:DADEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36853
Mailing Address - Country:US
Mailing Address - Phone:256-825-9900
Mailing Address - Fax:256-825-6620
Practice Address - Street 1:1034 SOUTH TALLASSEE STREET
Practice Address - Street 2:
Practice Address - City:DADEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36853
Practice Address - Country:US
Practice Address - Phone:256-825-9900
Practice Address - Fax:256-825-6620
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4555207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALM0009954235Medicaid
AL51521935OtherBLUE CROSS PROVIDER NUMBE
ALP00164084OtherMEDICARE RAILROAD
ALM0009954235Medicaid
ALC70253Medicare UPIN