Provider Demographics
NPI:1548254212
Name:EDWARD CHOCK MD INC
Entity type:Organization
Organization Name:EDWARD CHOCK MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-847-2201
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-0396
Mailing Address - Country:US
Mailing Address - Phone:209-847-2201
Mailing Address - Fax:209-847-0975
Practice Address - Street 1:1390 W H ST
Practice Address - Street 2:STE B
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3570
Practice Address - Country:US
Practice Address - Phone:209-847-2201
Practice Address - Fax:209-847-0975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37486208G00000X
CAG13634208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ91556ZMedicare ID - Type Unspecified
CAA39046Medicare UPIN
CAA47109Medicare UPIN