Individual
WILLIAM BRADFORD BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1589 SPARTA ST, SUITE 105, MC MINNVILLE, TN 37110-1390
(931) 815-3636
(931) 815-3808
Mailing address
1589 SPARTA ST, SUITE 105, MC MINNVILLE, TN 37110-1390
(931) 815-3636
(931) 815-3808
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD20114
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
193161
BLUE CROSS BLUE SHIELD
TN
05
—
3050246
—
TN
01
—
6215739330002
CIGNA
TN
Enumeration date
11/01/2006
Last updated
03/14/2019
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