Individual
JONATHAN WILLIAM CERAL BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
2318A SUNSET BLVD, WEST COLUMBIA, SC 29169-4716
(803) 796-9200
(803) 462-0312
Mailing address
601 CLEMSON RD, COLUMBIA, SC 29229-4341
(803) 788-6146
(803) 462-0312
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD34729
SC
Other
Enumeration date
06/18/2012
Last updated
07/15/2019
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