Individual
JACK GILBERT BROCK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
700 E MOREHEAD ST, STE 300, CHARLOTTE, NC 28202-2788
(704) 334-7800
(704) 414-7512
Mailing address
700 E MOREHEAD ST, STE 300, CHARLOTTE, NC 28202-2788
(704) 334-7800
(704) 414-7512
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0101036308
VA
2085R0202X
Diagnostic Radiology Physician
Primary
2000-01076
NC
2085R0202X
Diagnostic Radiology Physician
9301
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010171687
—
VA
05
—
89127K2
—
NC
Enumeration date
02/07/2006
Last updated
12/20/2017
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