# CHARLES BROCK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1871516021
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084N0400X | Neurology Physician | ME69227 | FL | — |
| 208VP0000X | Pain Medicine Physician | ME069227 | FL | Yes |
| 208VP0014X | Interventional Pain Medicine Physician | ME069227 | FL | — |

## Other

- **Enumeration date:** 07/26/2006
- **Last updated:** 04/05/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 254486500 | — | FL |
| 01 | — | 43672 | BLUE CROSS BLUE SHIELD | FL |