Provider Demographics
NPI:1992810485
Name:POCK, RYAN C (PA)
Entity type:Individual
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First Name:RYAN
Middle Name:C
Last Name:POCK
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Gender:M
Credentials:PA
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Mailing Address - Street 1:545 BRANSON LANDING BLVD
Mailing Address - Street 2:SUITE 408
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616
Mailing Address - Country:US
Mailing Address - Phone:417-335-7022
Mailing Address - Fax:417-334-6459
Practice Address - Street 1:545 BRANSON LANDING BLVD
Practice Address - Street 2:SUITE 408
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616
Practice Address - Country:US
Practice Address - Phone:417-335-7022
Practice Address - Fax:417-334-6459
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MO2000150990363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant