Individual
MR. DAVID WESLEY BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3550 N UNIVERSITY AVE, SUITE 250, PROVO, UT 84604-6683
(801) 374-9625
(801) 374-9690
Mailing address
100 N MARIO CAPECCHI DR, SUITE 250, SALT LAKE CITY, UT 84113-1103
(801) 662-5582
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
6725565-1206
UT
Other
Enumeration date
10/04/2007
Last updated
02/10/2016
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