Basic Information
| Provider Information | |||||||||
| NPI: | 1932207545 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOCK | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | FREDERICK | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 712 S CASCADE ST | ||||||||
| Address2: | |||||||||
| City: | FERGUS FALLS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565372913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187368000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 24 E 7TH ST | ||||||||
| Address2: | |||||||||
| City: | MORRIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 562671312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3205894008 | ||||||||
| FaxNumber: | 3205894227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 02/17/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 20829 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 432572900 | 05 | MN | MEDICAID | 121704 | 01 | MN | UCARE PROVIDER # | OTHER | 3T173ST | 01 | MN | BLUE CROSS PROVIDER # | OTHER | 110086056 | 01 | MN | RAILROAD MEDICARE # | OTHER |