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General NPI Number Information
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NPI Number | 1861451742
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Entity Type | Individual
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Provider Name | BROCK WELLS HORSLEY D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 2790 HEALTH PKWY
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City | MOUNT PLEASANT
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State | MI
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Zip | 48858-6934
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Country | US
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Telephone | 989-953-5320
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Fax | 989-802-8815
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Provider Business Mailing Address
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Address Line | 2790 HEALTH PKWY
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City | MT PLEASANT
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State | MI
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Zip | 48858-6934
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Country | US
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Telephone | 989-953-5320
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Fax | 989-953-5329
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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 | 5101014871
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License Number State | MI
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