Individual
MICHAEL DALTON BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
701 GROVE RD, 2ND FLOOR ANESTHESIA DEPT, GREENVILLE, SC 29605
(864) 455-7111
(864) 454-0888
Mailing address
300 E MCBEE AVE FL 124, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3110
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN1545
—
SC
Enumeration date
01/16/2007
Last updated
12/28/2021
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