Healthcare Provider Details

I. General information

NPI: 1962817841
Provider Name (Legal Business Name): JEREMY BROCK RRT, RCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JEREMY BROCK RRT

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 DATAPOINT DR. PARALLON WORKFORCE MANAGEMENT SOLUTIONS
SAN ANTONIO TX
78229
US

IV. Provider business mailing address

105 PHEASANT RIDGE DR
WARNER ROBINS GA
31088-6563
US

V. Phone/Fax

Practice location:
  • Phone: 210-593-0570
  • Fax:
Mailing address:
  • Phone: 478-955-9370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number76227
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number76627
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2279E0002X
TaxonomyEmergency Care Registered Respiratory Therapist
License Number76227
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2279E1000X
TaxonomyEducational Registered Respiratory Therapist
License Number76227
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number76227
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code2279P1004X
TaxonomyPulmonary Diagnostics Registered Respiratory Therapist
License Number76227
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: