Provider Demographics
NPI:1922113737
Name:STROCK, LOUIS L (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:L
Last Name:STROCK
Suffix:
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 1:800 8TH AVE STE 606
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2605
Mailing Address - Country:US
Mailing Address - Phone:817-335-1616
Mailing Address - Fax:817-335-1648
Practice Address - Street 1:800 8TH AVE STE 606
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2605
Practice Address - Country:US
Practice Address - Phone:817-335-1616
Practice Address - Fax:817-335-1648
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2014174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF78509Medicare UPIN