Healthcare Provider Details

I. General information

NPI: 1770864183
Provider Name (Legal Business Name): BROCK RONALD STURLAUGSON AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9894 ROSEMONT AVE STE 104
LONE TREE CO
80124-4102
US

IV. Provider business mailing address

8321 SANGRE DE CRISTO RD STE 202
LITTLETON CO
80127-6425
US

V. Phone/Fax

Practice location:
  • Phone: 303-792-9932
  • Fax: 303-792-9936
Mailing address:
  • Phone: 303-984-4414
  • Fax: 303-984-6244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number636
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: