Provider Demographics
NPI:1689943854
Name:MOCK, BRUCE ELLIOTT JR (PHD, AUD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ELLIOTT
Last Name:MOCK
Suffix:JR
Gender:M
Credentials:PHD, AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 MALLARD BAY RD
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-2584
Mailing Address - Country:US
Mailing Address - Phone:910-270-2961
Mailing Address - Fax:
Practice Address - Street 1:3909 WRIGHTSVILLE AVE
Practice Address - Street 2:# 110
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6241
Practice Address - Country:US
Practice Address - Phone:910-791-4755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-17
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9794237700000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist