Provider Demographics
NPI:1174746085
Name:MARK W. GOCKE MD, PA
Entity type:Organization
Organization Name:MARK W. GOCKE MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER BILLING COMPANY
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-748-2889
Mailing Address - Street 1:1025 MILITARY TRL
Mailing Address - Street 2:SUITE 113
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7040
Mailing Address - Country:US
Mailing Address - Phone:561-354-1002
Mailing Address - Fax:561-354-1003
Practice Address - Street 1:1025 MILITARY TRL
Practice Address - Street 2:SUITE 113
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7040
Practice Address - Country:US
Practice Address - Phone:561-354-1002
Practice Address - Fax:561-354-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58960207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME58960OtherSTATE LICENSE
FLE95281Medicare UPIN