Individual
BROCK ANTHONY DERRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1255 PEARL ST, EUGENE, OR 97401-3570
(541) 687-6983
(541) 762-1571
Mailing address
440 MELVILL CRES, PHILOMATH, OR 97370-9438
(541) 908-6926
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/20/2021
Last updated
10/22/2021
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