Provider Demographics
NPI:1497780209
Name:CHOCK, DEVORAH ALANA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEVORAH
Middle Name:ALANA
Last Name:CHOCK
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 1:125 130TH ST SE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208
Mailing Address - Country:US
Mailing Address - Phone:425-385-2263
Mailing Address - Fax:425-385-8476
Practice Address - Street 1:125 130TH ST SE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208
Practice Address - Country:US
Practice Address - Phone:425-385-2263
Practice Address - Fax:425-385-8476
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65092208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A650920Medicaid
CAH43581Medicare UPIN
CA00A650920Medicaid