Individual
BROCK RANDALL ANGELOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
4213 O ST, LINCOLN, NE 68510-1751
(402) 488-8114
Mailing address
4213 O ST, LINCOLN, NE 68510-1751
(402) 488-8114
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
194
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02593
BCBS
—
05
—
47070731200
—
NE
Enumeration date
08/31/2006
Last updated
07/08/2007
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