Individual
MR. STEPHEN PAUL MOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1 SHIRA FIELDHOUSE, LAKEVIEW DRIVE, MISSISSIPPI STATE, MS 39762
(662) 325-2165
Mailing address
102 MIMOSA DR, STARKVILLE, MS 39759-4353
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0030
MS
Other
Enumeration date
09/06/2006
Last updated
07/08/2007
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