Provider Demographics
NPI:1689696874
Name:SCHOCK, TONY RICHARD (PA)
Entity Type:Individual
Prefix:MR
First Name:TONY
Middle Name:RICHARD
Last Name:SCHOCK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19070 E SUNLIGHT WAY
Mailing Address - Street 2:MS36, BUCKLEY AFB
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-9574
Mailing Address - Country:US
Mailing Address - Phone:720-250-6994
Mailing Address - Fax:720-250-1959
Practice Address - Street 1:19070 E SUNLIGHT WAY
Practice Address - Street 2:MS36, BUCKLEY AFB
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-9574
Practice Address - Country:US
Practice Address - Phone:720-250-6994
Practice Address - Fax:720-250-1959
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1475363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1475OtherSTATE LICENSE