Basic Information
| Provider Information | |||||||||
| NPI: | 1700865219 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHOCK | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | CONRAD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 CHRISTY LANE | ||||||||
| Address2: | |||||||||
| City: | MAUMELLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703472534 | ||||||||
| FaxNumber: | 8703473492 | ||||||||
| Practice Location | |||||||||
| Address1: | 227 PINE BLUFF HWY | ||||||||
| Address2: | |||||||||
| City: | ENGLAND | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720462234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703473314 | ||||||||
| FaxNumber: | 8703473492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2006 | ||||||||
| LastUpdateDate: | 05/15/2012 | ||||||||
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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 | 207XS0117X | AS1265291 | AR | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207Q00000X | R2963 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 177379749 | 05 | AR | MEDICAID | 104890007 | 05 | AR | MEDICAID | 104890001 | 05 | AR | MEDICAID |