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Individual
RICHARD JOHN BROCK
Active
Individual
RICHARD JOHN BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
512613
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002831802
—
TX
01
—
470862522
TAX ID
TX
01
—
S28032
UPIN
TX
Enumeration date
12/06/2006
Last updated
07/08/2007
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