Provider Demographics
NPI:1699933572
Name:KLOCEK, SHAWN CHRISTOFFER (PA-C)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:CHRISTOFFER
Last Name:KLOCEK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10909 SANDMAN DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1982
Mailing Address - Country:US
Mailing Address - Phone:505-792-9259
Mailing Address - Fax:
Practice Address - Street 1:9201 MONTGOMERY BLVD NE
Practice Address - Street 2:AFTER HOURS PEDIATRICS SUITE 201
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2468
Practice Address - Country:US
Practice Address - Phone:505-298-2505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2008-0019363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant