Provider Demographics
NPI:1639102692
Name:YOCK, DOUGLAS HAROLD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:HAROLD
Last Name:YOCK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4700 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1520
Mailing Address - Country:US
Mailing Address - Phone:952-920-4777
Mailing Address - Fax:
Practice Address - Street 1:800 E 28TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3723
Practice Address - Country:US
Practice Address - Phone:612-863-5195
Practice Address - Fax:612-863-2597
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN236882085N0700X
CAG274882085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN23026OtherAMERICA'S PPO
MN27315YOOtherBLUE CROSS AND BLUE SHIELD OF MN
MN496863800Medicaid
MNHP14734OtherHEALTHPARTNERS
MN0009300OtherPREFERRED ONE
IA1904268Medicaid
WI300038140OtherRAILROAD MEDICARE WI
MN100722OtherUCARE
MN300065114OtherRAILROAD MEDICARE MN
WI31636200Medicaid
MN0009300OtherPREFERRED ONE
MNHP14734OtherHEALTHPARTNERS
MN300003002Medicare PIN