Provider Demographics
NPI:1548351513
Name:GOCKE, STEPHEN EDMUND (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:EDMUND
Last Name:GOCKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 E DANENBERG DR
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-8511
Mailing Address - Country:US
Mailing Address - Phone:760-352-2257
Mailing Address - Fax:760-344-1629
Practice Address - Street 1:852 E DANENBERG DR
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-8511
Practice Address - Country:US
Practice Address - Phone:760-352-2257
Practice Address - Fax:760-352-1629
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48685207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G48652Medicaid
A51141Medicare UPIN
CAW15552Medicare ID - Type Unspecified