Individual
PAUL MICHAEL BROCK III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
908 E 16TH ST STE B, WILMINGTON, DE 19802-5145
(302) 575-1414
Mailing address
2007 FAIRMOUNT AVE APT 14, PHILADELPHIA, PA 19130-2631
(240) 418-1334
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C5-0012004
DE
363AM0700X
Medical Physician Assistant
C5-0012004
DE
Other
Enumeration date
11/17/2023
Last updated
11/17/2023
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