Provider Demographics
NPI:1922041425
Name:BOCK, WILLIAM CLIFFORD (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CLIFFORD
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10650 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8538
Practice Address - Country:US
Practice Address - Phone:704-667-3840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30603207R00000X, 207RC0001X, 207RC0000X, 207RC0000X, 207RC0001X
SC19317207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN30603Medicaid
NC8916401Medicaid
NC1922041425Medicaid
NC16401OtherBCBS
NC204869BMedicare PIN
NC1922041425Medicaid
SCN30603Medicaid
NC204869DMedicare PIN
SCC828545332Medicare PIN
NC211981AMedicare PIN
SCC828548186Medicare PIN
NC16401OtherBCBS
NCC82854Medicare UPIN
SCC828547772Medicare PIN
NC204869CMedicare PIN