Individual
DR. JAMES BENJAMIN BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5560
(601) 984-5565
Mailing address
2500 N STATE ST, DIVISION OF INFECTIOUS DISEASES, JACKSON, MS 39216-4500
(601) 984-5560
(601) 984-5565
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
21425
MS
207RI0200X
Infectious Disease Physician
Primary
21425
MS
208000000X
Pediatrics Physician
21425
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03679540
—
MS
01
—
P01667060
RAILROAD MEDICARE
MS
Enumeration date
07/02/2009
Last updated
10/31/2016
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