Provider Demographics
NPI:1487637179
Name:BOK, WILLEM EDUARD (MD)
Entity Type:Individual
Prefix:
First Name:WILLEM
Middle Name:EDUARD
Last Name:BOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DUARD
Other - Middle Name:
Other - Last Name:BOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:134 E REBOUND RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-7712
Mailing Address - Country:US
Mailing Address - Phone:803-313-3700
Mailing Address - Fax:803-289-0912
Practice Address - Street 1:134 E REBOUND ROAD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-7712
Practice Address - Country:US
Practice Address - Phone:803-313-3700
Practice Address - Fax:803-289-0912
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC817722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C13575Medicare UPIN