Individual
MR. CHARLES L. KOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
201 DENNING DR, HOUMA, LA 70360-3977
(985) 855-4829
Mailing address
201 DENNING DR., HOUMA, LA 70360
(985) 855-4829
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
A10076
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1624845
—
LA
01
—
970006535
RR MEDICARE
LA
Enumeration date
12/09/2005
Last updated
01/06/2015
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