Individual
BROCK ARMSTRONG LIDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
210 SHARON RD STE A, CIRCLEVILLE, OH 43113-1498
(740) 474-3850
(888) 821-9123
Mailing address
PO BOX 693, PICKERINGTON, OH 43147-0693
(740) 474-3850
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
36-00-3103-L
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2095281
—
OH
01
—
7887840001
NATIONAL SUPPLIER CLEARINGHOUSE
OH
01
—
P00287259
RR MEDICARE R PIN
—
Enumeration date
07/05/2005
Last updated
06/08/2021
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