Provider Demographics
NPI:1013963172
Name:MOCK, PRESLEY M (MD)
Entity Type:Individual
Prefix:
First Name:PRESLEY
Middle Name:M
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 1:8440 WALNUT HILL LN
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3833
Mailing Address - Country:US
Mailing Address - Phone:214-345-1494
Mailing Address - Fax:214-345-1452
Practice Address - Street 1:8440 WALNUT HILL LN
Practice Address - Street 2:STE 500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3833
Practice Address - Country:US
Practice Address - Phone:214-345-1491
Practice Address - Fax:214-345-5708
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2615207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125805502Medicaid
TX040007318OtherRAILROAD MEDICARE
TX040007318OtherRAILROAD MEDICARE
TX87W818Medicare ID - Type Unspecified