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General NPI Number Information
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NPI Number | 1124121108
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Entity Type | Individual
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Provider Name | JANA JOHNSON BROCK MD
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Gender | Female
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 04/03/2023
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Provider Practice Location Address
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Address Line | 3108 W STATE HIGHWAY 22
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City | CORSICANA
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State | TX
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Zip | 75110-2435
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Country | US
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Telephone | 660-833-7554
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Fax |
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Provider Business Mailing Address
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Address Line | 3108 W STATE HIGHWAY 22
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City | CORSICANA
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State | TX
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Zip | 75110-2435
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Country | US
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Telephone |
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Fax |
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | P0011
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License Number State | TX
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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 | P0011
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License Number State | TX
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