Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | H2615 | TX |
NPI | 1013963172 |
---|---|
Provider Name | Presley M. Mock |
First Address | Dallas, TX 75231-3833 |
Second Address | Dallas, TX 75231-3833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 13/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040007318 | RAILROAD MEDICARE (01) | TX |
125805502 | (05) | TX |
B95706 | (02) | TX |