Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | MD424824 | PA |
NPI | 1942275227 |
---|---|
Provider Name | Dr. Glenn H. Bock |
First Address | Danville, PA 17822-3034 |
Second Address | Danville, PA 17822-1339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C88537 | (02) |