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General NPI Number Information
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NPI Number | 1689854523
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Entity Type | Organization
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Legal Business Name | ROBERT J BROCK MD PC
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 480 S CACHE
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City | JACKSON
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State | WY
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Zip | 83001-0941
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Country | US
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Telephone | 307-733-8333
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Fax | 307-733-7929
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Provider Business Mailing Address
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Address Line | PO BOX 941 480 S CACHE
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City | JACKSON
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State | WY
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Zip | 83001-0941
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Country | US
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Telephone | 307-733-8333
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Fax | 307-733-7929
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT JAMES BROCK
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Credential | M.D.
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Telephone | 307-733-8333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 7758A
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License Number State | WY
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