Provider Demographics
NPI:1639195365
Name:GOCHOCO, JOSE L (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:GOCHOCO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4450
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86402-4450
Mailing Address - Country:US
Mailing Address - Phone:928-718-4375
Mailing Address - Fax:928-222-0227
Practice Address - Street 1:2002 N STOCKTON HILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4698
Practice Address - Country:US
Practice Address - Phone:928-718-4375
Practice Address - Fax:928-222-0227
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1715207PE0004X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ295487Medicaid
AZE35664Medicare UPIN
AZZ78502Medicare PIN