Individual
BRIAN E KLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 E MOUNTAIN BLVD, WILKES BARRE, PA 18711-0027
(570) 808-2340
(570) 808-7904
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
(570) 271-6578
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD058618L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015753350003
—
PA
Enumeration date
11/30/2005
Last updated
08/21/2020
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