Individual
BRANDON RAYMOND BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1011 BRAZOS DR, SOUTHLAKE, TX 76092-6027
(225) 610-2051
Mailing address
1011 BRAZOS DR, SOUTHLAKE, TX 76092-6027
(225) 610-2051
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
094793
LA
367500000X
Certified Registered Nurse Anesthetist
Primary
AP123128
TX
Other
Enumeration date
03/18/2008
Last updated
05/22/2016
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