Provider Demographics
NPI:1609389097
Name:BOCKMANN, JOHN CHARLES (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:BOCKMANN
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:11766A ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:FORT DRUM
Mailing Address - State:NY
Mailing Address - Zip Code:13603-3126
Mailing Address - Country:US
Mailing Address - Phone:615-974-2093
Mailing Address - Fax:
Practice Address - Street 1:CONNOR TROOP MEDICAL CLINIC
Practice Address - Street 2:10506 EUPHRATES RIVER VALLEY RD
Practice Address - City:FORT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13602
Practice Address - Country:US
Practice Address - Phone:615-974-2093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant