Provider Demographics
NPI:1932207545
Name:STOCK, JOHN FREDERICK (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FREDERICK
Last Name:STOCK
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 1:712 S CASCADE ST
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2913
Mailing Address - Country:US
Mailing Address - Phone:218-736-8000
Mailing Address - Fax:
Practice Address - Street 1:24 E 7TH ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:MN
Practice Address - Zip Code:56267-1312
Practice Address - Country:US
Practice Address - Phone:320-589-4008
Practice Address - Fax:320-589-4227
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20829207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN432572900Medicaid
MN121704OtherUCARE PROVIDER #
MN3T173STOtherBLUE CROSS PROVIDER #
MN110086056OtherRAILROAD MEDICARE #
MN110086056OtherRAILROAD MEDICARE #
MN432572900Medicaid
MN3T173STOtherBLUE CROSS PROVIDER #