Provider Demographics
NPI:1790789576
Name:SCHOCK, JOEL FLOYD IV (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:FLOYD
Last Name:SCHOCK
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3290 20TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-5917
Mailing Address - Country:US
Mailing Address - Phone:701-499-4800
Mailing Address - Fax:701-451-9452
Practice Address - Street 1:3290 20TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-5917
Practice Address - Country:US
Practice Address - Phone:701-499-4800
Practice Address - Fax:701-451-9452
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN29157207Q00000X
ND4892207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN068K7SCOtherMN BLUE SHIELD
MN892937800Medicaid
NDSCH23164OtherN DAKOTA BLUE SHIELD
ND16541Medicaid
NDP00057347OtherRAILROAD MEDICARE
NDD26273Medicare UPIN
ND16541Medicaid