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General NPI Number Information
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NPI Number | 1033145123
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Entity Type | Organization
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Legal Business Name | IRVIN P. BROCK III, M.D., P.A.
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 160 CREEKSIDE PARK SUITE 202
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City | BULVERDE
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State | TX
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Zip | 78163
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Country | US
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Telephone | 830-438-4788
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Fax |
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Provider Business Mailing Address
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Address Line | 320 FOSSIL HILLS LOOP
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City | SPRING BRANCH
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State | TX
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Zip | 78070-6012
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Country | US
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Telephone | 830-885-2193
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IRVIN PETE BROCK III
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Credential | MD
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Telephone | 830-438-4788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | M1535
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License Number State | TX
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