Theron Clay Mock Jr., M. D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

35-04-5230 Issued in OH

Practice address

465 Gypsy LN
Apt 312
Youngstown, OH 44504-1361

Phone

(330) 746-5111

Fax

(330) 746-5111

NPI assigned

May 22, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1932319894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "465 GYPSY LN",
            "address_2": "APT 312",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445041361",
            "telephone_number": "330-746-5111",
            "fax_number": "330-746-5111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "465 GYPSY LN",
            "address_2": "APT 312",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445041361",
            "telephone_number": "330-746-5111",
            "fax_number": "330-746-5111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOCK",
        "first_name": "THERON",
        "middle_name": "CLAY",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M. D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "35-04-5230",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0976412",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Myka Antwanette Mitchum
• Mitchell Stone Miterko, MD
• Scott Mix, R.N.
• Jaquon Andre Mixon
• Mmcmurray, O.D., LLC
• Lisa Marie Modelski, PT
• Raina Moffett
• Basanta K Mohapatra, MD
• Bailey Mohn, B.S.
• Sean Arshia Mohtashami, DO

• Surgery Physician in Youngstown, OH
• Providers in Youngstown, OH by specialty
• Surgery Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.