Provider Demographics
NPI:1013932680
Name:MAYOCK, DENNIS
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:MAYOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PEDIATRICS, BOX 356320
Mailing Address - Street 2:UNIVERSITY OF WASHINGTON
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-6320
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PEDIATRICS, BOX 356320
Practice Address - Street 2:UNIVERSITY OF WASHINGTON
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6320
Practice Address - Country:US
Practice Address - Phone:206-543-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000163912080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8101792Medicaid
WA8101792Medicaid