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General NPI Number Information
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NPI Number | 1912563149
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Entity Type | Individual
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Provider Name | BROCK ROBERT MILLS DO
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Gender | Male
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Dates
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Enumeration Date | 05/13/2019
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Last Update Date | 06/16/2022
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Provider Practice Location Address
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Address Line | 2333 MCCALLIE AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37404-3258
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Country | US
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Telephone | 423-698-6061
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Fax |
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Provider Business Mailing Address
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Address Line | 5400 WINDROSE LN
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City | AMES
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State | IA
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Zip | 50014-2205
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Country | US
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Telephone | 515-313-6837
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4619
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License Number State | TN
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