Provider Demographics
NPI:1649208653
Name:BOCK, PAUL JEROME (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JEROME
Last Name:BOCK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7301 OHMS LANE
Mailing Address - Street 2:SUITE 650
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439
Mailing Address - Country:US
Mailing Address - Phone:952-835-9880
Mailing Address - Fax:952-857-1554
Practice Address - Street 1:6500 EXCELSIOR BLVD
Practice Address - Street 2:METHODIST HOSPITAL
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55426
Practice Address - Country:US
Practice Address - Phone:952-993-6080
Practice Address - Fax:952-993-6047
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
MI48426207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BB9659282OtherDEA