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General NPI Number Information
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NPI Number | 1043286594
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Entity Type | Individual
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Provider Name | JOSEPH L BROCK MD
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Gender | Male
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Dates
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Enumeration Date | 02/24/2006
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Last Update Date | 12/04/2014
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Provider Practice Location Address
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Address Line | 246 GRANGER RD SUITE 2
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City | BARRE
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State | VT
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Zip | 05641-5344
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Country | US
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Telephone | 802-225-5810
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Fax | 802-371-4821
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Provider Business Mailing Address
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Address Line | PO BOX 547 ATT: CVMC FINANCE DEPT
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City | BARRE
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State | VT
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Zip | 05641-0547
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Country | US
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Telephone | 802-225-5810
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Fax | 802-371-4821
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301047460
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 042.0011623
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License Number State | VT
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