Provider Demographics
NPI:1699792663
Name:QUOCK, JUSTIN P (MD, FACP)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:P
Last Name:QUOCK
Suffix:
Gender:M
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 CLAY ST
Mailing Address - Street 2:STE 207
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-1569
Mailing Address - Country:US
Mailing Address - Phone:415-398-5100
Mailing Address - Fax:415-837-1408
Practice Address - Street 1:929 CLAY ST
Practice Address - Street 2:STE 207
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1569
Practice Address - Country:US
Practice Address - Phone:415-398-5100
Practice Address - Fax:415-837-1408
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55916207RX0202X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A55916000Medicaid
CAG62425Medicare UPIN