MEDICARE: GINA BROCK DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS22051	FL
2	207P00000X	Emergency Medicine Physician	PA9102907	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00164456	OTHER	FL	RAILROAD MEDICARE - FLAGL

General Provider Information

NPI Number	:	1154374668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA BROCK DO

Provider Business Mailing Address
First Line	:	1107 E 66TH ST
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31404-5701
Country	:	US
Telephone Number	:	912-350-8837
Fax Number	:	912-350-5118

Provider Business Practice Location Address
First Line	:	4700 WATERS AVE
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31404-6220
Country	:	US
Telephone Number	:	912-350-8715
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	04/22/2026

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Directions to “ GINA BROCK DO” Practice Location

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