Provider Demographics
NPI:1811190556
Name:BOCKEWITZ, ELIZABETH GAGE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:GAGE
Last Name:BOCKEWITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 LOWER BROOK DR
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-7457
Mailing Address - Country:US
Mailing Address - Phone:309-397-9624
Mailing Address - Fax:
Practice Address - Street 1:601 N ELM ST
Practice Address - Street 2:ATTN: REGIONAL EMERGENCY PHYSICIANS
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4331
Practice Address - Country:US
Practice Address - Phone:309-655-6710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-051-386207P00000X
NC2009-01288207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine