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Individual

DR. ETHAN J SCHOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
800 FAIR PARK BLVD, LITTLE ROCK, AR 72204
(501) 663-3647
(501) 666-9653
Mailing address
800 FAIR PARK BLVD, LITTLE ROCK, AR 72204-1720
(501) 663-3647
(501) 666-9653

Taxonomy

Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
E-2961
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
145157001
AR
01
5L876C207
MEDICARE PTAN
AR
Enumeration date
01/06/2006
Last updated
07/06/2018
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