Provider Demographics
NPI:1558422675
Name:KLOCK, JOHN CHARLES JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHARLES
Last Name:KLOCK
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:345 WILLOW ROAD
Mailing Address - Street 2:511
Mailing Address - City:NICASIO
Mailing Address - State:CA
Mailing Address - Zip Code:94946-0511
Mailing Address - Country:US
Mailing Address - Phone:415-662-2553
Mailing Address - Fax:415-662-2127
Practice Address - Street 1:333 WILLOW ROAD
Practice Address - Street 2:511
Practice Address - City:NICASIO
Practice Address - State:CA
Practice Address - Zip Code:94946-0511
Practice Address - Country:US
Practice Address - Phone:415-662-2553
Practice Address - Fax:415-662-2127
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG20664174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist