Provider Demographics
NPI:1851443444
Name:HOCKER JR., CLIFTON M JR (MD)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:M
Last Name:HOCKER JR.
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:326 S WOODSCREST DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5314
Practice Address - Country:US
Practice Address - Phone:812-353-6888
Practice Address - Fax:812-269-3771
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027779A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN080182705OtherRR MEDICARE
IN100116770Medicaid
IN100116770Medicaid
IN331450MMedicare PIN
IN252630LMedicare PIN