Provider Demographics
NPI:1649274481
Name:BOCK, JEFFREY S (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:BOCK
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:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57402-1460
Mailing Address - Country:US
Mailing Address - Phone:605-225-0378
Mailing Address - Fax:605-225-7919
Practice Address - Street 1:105 S STATE ST
Practice Address - Street 2:SUITE 113
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4500
Practice Address - Country:US
Practice Address - Phone:605-225-0378
Practice Address - Fax:605-225-7919
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND10217Medicaid
SD5610100Medicaid
SD5610102Medicaid
SD5610100Medicaid
ND10217Medicaid
SDS4933Medicare PIN