Healthcare Provider Details

I. General information

NPI: 1649589904
Provider Name (Legal Business Name): DR. SYLVIA EUNICE BROCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SYLVIA EUNICE BROCK M.D.

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 MOUNTAINVIEW RD
CHEWELAH WA
99109-9642
US

IV. Provider business mailing address

3302 MOUNTAINVIEW RD
CHEWELAH WA
99109-9642
US

V. Phone/Fax

Practice location:
  • Phone: 509-675-0758
  • Fax:
Mailing address:
  • Phone: 509-675-0758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16251
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: