Organization
LEVEL 4 MEDICAL PROFESSIONAL CORPORATION
Active
Other names
Stockton Lake Walkin Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID E SMOCK MD (OWNER)
(928) 503-4261
Entity
Organization
Contact information
Practice address
913 SOUTH ST, STOCKTON, MO 65785-9381
(417) 809-8620
Mailing address
913 SOUTH ST, STOCKTON, MO 65785-9307
(417) 809-8620
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
2003017056
MO
Other
Enumeration date
08/05/2010
Last updated
01/29/2015
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