Provider Demographics
NPI:1528173226
Name:POCK, RANDOLPH W (MD)
Entity type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:W
Last Name:POCK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4495 HALE PKWY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-6210
Mailing Address - Country:US
Mailing Address - Phone:303-322-0313
Mailing Address - Fax:303-377-0059
Practice Address - Street 1:155 SOUTH MADISON ST
Practice Address - Street 2:#301
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209
Practice Address - Country:US
Practice Address - Phone:303-322-0313
Practice Address - Fax:303-377-0059
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO17579101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO802958Medicare PIN