Individual
NEAL ROSS BROCKBANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
212 N MAIN ST, FAIRFAX, OK 74637-3023
(918) 642-3100
(918) 642-5415
Mailing address
212 N MAIN ST, FAIRFAX, OK 74637-3023
(918) 642-3100
(918) 642-5415
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5853
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05-30121
LICENSE #
KS
05
—
100451050C
—
KS
05
—
200606010A
—
OK
Enumeration date
02/15/2006
Last updated
08/14/2017
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