Individual
DAVID THOMAS BROCKBANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1055 N 500 W STE 201, PROVO, UT 84604-3305
(801) 375-6565
(801) 373-9750
Mailing address
1055 N 500 W, ATTN: CREDENTIALING, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
6540468-1205
UT
207W00000X
Ophthalmology Physician
T2003013455
MO
Other
Enumeration date
08/23/2006
Last updated
02/25/2026
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