Provider Demographics
NPI:1407942154
Name:MOCK, EDGAR MENFUG
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:MENFUG
Last Name:MOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 NE 164TH STREET
Mailing Address - Street 2:
Mailing Address - City:NO MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162
Mailing Address - Country:US
Mailing Address - Phone:305-940-6714
Mailing Address - Fax:305-940-9514
Practice Address - Street 1:2014 NE 164TH STREET
Practice Address - Street 2:
Practice Address - City:NO MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162
Practice Address - Country:US
Practice Address - Phone:305-940-6714
Practice Address - Fax:305-940-9514
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3110237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist