Individual
MITCH EDMOND BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9800 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-9750
(503) 653-6440
Mailing address
1203 STONEHAVEN CT, WEST LINN, OR 97068-1870
(503) 635-7389
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
MD00034914
WA
207Y00000X
Otolaryngology Physician
Primary
MD19303
OR
Other
Enumeration date
08/31/2006
Last updated
02/04/2022
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