Individual
MR. JARED L BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4001 W GOELLER BLVD STE A, COLUMBUS, IN 47201-8309
(812) 375-3330
(812) 375-3329
Mailing address
PO BOX 775383, CHICAGO, IL 60677-5383
(812) 376-5315
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000575A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000991456
ANTHEM PIN
IN
01
—
10000575A
INDIANA LICENSE
IN
Enumeration date
06/02/2006
Last updated
09/09/2024
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