Healthcare Provider Details

I. General information

NPI: 1518907732
Provider Name (Legal Business Name): STEVEN BROCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 INTERSTATE 20 W SUITE 120
ARLINGTON TX
76017-5870
US

IV. Provider business mailing address

811 W I-20 SUITE 120
ARLINGTON TX
76017-5870
US

V. Phone/Fax

Practice location:
  • Phone: 817-468-3393
  • Fax: 817-468-8734
Mailing address:
  • Phone: 817-468-3393
  • Fax: 817-468-8734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberF1405
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: