Provider Demographics
NPI:1477840072
Name:BOCK, FELICIA (DPM)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:BOCK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18643-2741
Mailing Address - Country:US
Mailing Address - Phone:570-654-4371
Mailing Address - Fax:570-654-0455
Practice Address - Street 1:810 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:WEST PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18643-2741
Practice Address - Country:US
Practice Address - Phone:570-654-4371
Practice Address - Fax:570-654-0455
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006276213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery