# JAY DAVID BROCK, MD, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053359968
- **Authorized official:** JAY D. BROCK M.D. (PHYSICIAN)
- **Authorized official phone:** (540) 891-5600

## Contact information

- **Practice address:** 4304 LAFAYETTE BLVD, FREDERICKSBURG, VA 22408-4234
- **Practice address phone:** (540) 891-5600
- **Practice address fax:** (540) 891-9034
- **Mailing address:** 4304 LAFAYETTE BLVD, FREDERICKSBURG, VA 22408-4234
- **Mailing address phone:** (540) 891-5600
- **Mailing address fax:** (540) 891-9034

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 0101032059 | VA | Yes |

## Other

- **Enumeration date:** 06/03/2006
- **Last updated:** 05/03/2010