Individual
DR. THERON CLAY MOCK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
465 GYPSY LN, APT 312, YOUNGSTOWN, OH 44504-1361
(330) 746-5111
(330) 746-5111
Mailing address
465 GYPSY LN, APT 312, YOUNGSTOWN, OH 44504-1361
(330) 746-5111
(330) 746-5111
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
35-04-5230
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0976412
—
OH
Enumeration date
05/22/2007
Last updated
07/08/2007
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