Provider Demographics
NPI:1932196896
Name:MOCK, ROBERT D (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:MOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1120 MEDICAL PLAZA DR
Mailing Address - Street 2:STE 380
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3242
Mailing Address - Country:US
Mailing Address - Phone:281-363-3311
Mailing Address - Fax:281-363-3158
Practice Address - Street 1:1120 MEDICAL PLAZA DR
Practice Address - Street 2:STE 380
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3242
Practice Address - Country:US
Practice Address - Phone:281-363-3311
Practice Address - Fax:281-363-3158
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE9814207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139648304Medicaid
TX00CR18Medicare ID - Type Unspecified
TX139648304Medicaid