Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | D89638 | MD |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD464947 | PA |
NPI | 1063657310 |
---|---|
Provider Name | Dr. Jeremy Alexander Mock |
First Address | Danville, PA 17822-4903 |
Second Address | Danville, PA 17822-0006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2008 |
Last Update Date | 19/08/2020 |