Healthcare Provider Details

I. General information

NPI: 1720999790
Provider Name (Legal Business Name): BRYAN KROCK PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4415 E COTTON CENTER BLVD STE 100
PHOENIX AZ
85040-8903
US

IV. Provider business mailing address

750 W JOHN CARPENTER FWY STE 800
IRVING TX
75039-2520
US

V. Phone/Fax

Practice location:
  • Phone: 888-979-8669
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZG1000X
TaxonomyMedical Geneticist (PhD) Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: