Provider Demographics
NPI:1205959475
Name:MOCKLI, GARY CRAIG
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:CRAIG
Last Name:MOCKLI
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 1:2040 CONCOURSE DR
Mailing Address - Street 2:QUEST DIAGNOSTICS
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4119
Mailing Address - Country:US
Mailing Address - Phone:314-872-3733
Mailing Address - Fax:
Practice Address - Street 1:2040 CONCOURSE DR
Practice Address - Street 2:QUEST DIAGNOSTICS
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4119
Practice Address - Country:US
Practice Address - Phone:314-872-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114040207ZP0102X
NE23146207ZP0102X
ARE-1874207ZP0102X
CAG63829207ZP0102X
KS0431136207ZP0102X
IN01048819A207ZP0102X
SD5994207ZP0102X
WAMD00044754207ZP0102X
IA37009207ZP0102X
OK25391207ZP0102X
TNMD0000041798207ZP0102X
IL207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOFO1631Medicare UPIN