Provider Demographics
NPI:1942308101
Name:MOCK, GREGORY P (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:P
Last Name:MOCK
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:PO BOX 17930
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72222-7930
Mailing Address - Country:US
Mailing Address - Phone:501-663-0490
Mailing Address - Fax:501-663-5948
Practice Address - Street 1:403 S POPLAR ST STE D
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6000
Practice Address - Country:US
Practice Address - Phone:501-279-7077
Practice Address - Fax:501-279-3970
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20865207RN0300X
ARE8397207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR203317001Medicaid
MT000091141OtherBCBS PIN
WY115067700OtherMDCD PIN
WY308585OtherBCBS PIN
MT0023970OtherMDCD PIN
AR203317001Medicaid
MT000081544Medicare PIN
AR347374YN39Medicare PIN
WY115067700OtherMDCD PIN
MT000091141OtherBCBS PIN
MT0023970OtherMDCD PIN
WYW308585Medicare PIN