Individual
BROCK BLEAZARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1303 N MAIN ST, CEDAR CITY, UT 84721-9746
(435) 868-5300
Mailing address
1303 N MAIN ST, CEDAR CITY, UT 84721-9746
(435) 868-5300
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
SL0941
NV
2085R0202X
Diagnostic Radiology Physician
Primary
11745801-1204
UT
Other
Enumeration date
06/10/2013
Last updated
08/05/2020
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