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NPI Code Detail

MEDICARE: BROCK J DOUBLEDEE D.O.

MEDICARE: BROCK J DOUBLEDEE D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician47322MN
22080P0206XPediatric Gastroenterology Physician5852SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013994730
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROCK J DOUBLEDEE D.O.
Provider Business Mailing Address
First Line : PO BOX 5074
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57117-5074
Country : US
Telephone Number : 605-312-1000
Fax Number : 605-312-1001
Provider Business Practice Location Address
First Line : 1600 W 22ND
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57105-1521
Country : US
Telephone Number : 605-312-1000
Fax Number : 605-312-1001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2005
Last Update Date : 04/04/2022

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Directions to “ BROCK J DOUBLEDEE D.O.” Practice Location

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