Individual
BROCK WIDDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13620 CRAYTON BLVD STE A, HAGERSTOWN, MD 21742-2335
(240) 313-3100
Mailing address
13620 CRAYTON BLVD STE A, HAGERSTOWN, MD 21742-2335
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0009466
MD
Other
Enumeration date
07/12/2024
Last updated
07/12/2024
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