Individual
BROCK VICKERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 E BOULDER ST, COLORADO SPRINGS, CO 80909-5533
(719) 365-1229
Mailing address
8890 N UNION BLVD, STE 160, COLORADO SPRINGS, CO 80920-7799
(719) 365-9950
(719) 365-9969
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
33229
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01332295
—
CO
Enumeration date
06/17/2005
Last updated
03/23/2016
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