Organization
JAY DAVID BROCK, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAY D. BROCK M.D. (PHYSICIAN)
(540) 891-5600
Entity
Organization
Contact information
Practice address
4304 LAFAYETTE BLVD, FREDERICKSBURG, VA 22408-4234
(540) 891-5600
(540) 891-9034
Mailing address
4304 LAFAYETTE BLVD, FREDERICKSBURG, VA 22408-4234
(540) 891-5600
(540) 891-9034
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101032059
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5690803
—
VA
Enumeration date
06/03/2006
Last updated
05/03/2010
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