Healthcare Provider Details

I. General information

NPI: 1144323494
Provider Name (Legal Business Name): RONALD A. BROCK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 E SPRUCE ST
GARDEN CITY KS
67846
US

IV. Provider business mailing address

6001 SW 6TH AVE SUITE 200
TOPEKA KS
66615-1011
US

V. Phone/Fax

Practice location:
  • Phone: 620-275-3030
  • Fax: 620-275-3025
Mailing address:
  • Phone: 785-233-7491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: