Provider Demographics
NPI:1881895480
Name:BOCK, GERALD W (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:W
Last Name:BOCK
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 1:8573 CORDES CIRCLE
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139
Mailing Address - Country:US
Mailing Address - Phone:901-754-6733
Mailing Address - Fax:901-754-7808
Practice Address - Street 1:8573 CORDES CIRCLE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38139
Practice Address - Country:US
Practice Address - Phone:901-754-6733
Practice Address - Fax:901-754-7808
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN024134OtherTN LICENSE NUMBER
TN024134OtherTN LICENSE NUMBER