Healthcare Provider Details

I. General information

NPI: 1871859611
Provider Name (Legal Business Name): JAMES PHILIP BROCK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 JACKSON ST
DENVER CO
80206
US

IV. Provider business mailing address

1400 JACKSON ST
DENVER CO
80206
US

V. Phone/Fax

Practice location:
  • Phone: 303-388-4461
  • Fax: 303-398-1211
Mailing address:
  • Phone: 303-388-4461
  • Fax: 303-398-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number20A13058
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberDR.0064907
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: