Individual
GERALD K BROCKER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
975 E. THIRD STREET, CHATTANOOGA, TN 37403-2147
(423) 602-8400
(423) 602-8401
Mailing address
PO BOX 2930, INDIANAPOLIS, IN 46206-2930
(844) 468-9496
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
043334
GA
207L00000X
Anesthesiology Physician
Primary
MD22077
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000500596A
—
GA
05
—
009204600
—
AL
01
—
050047698
RR MEDICARE
TN
01
—
3038764
BLUE CROSS BLUE SHIELD OF TN
TN
05
—
890692T
—
NC
01
—
N348394
WELLCARE (GA MEDICAID)
GA
05
—
Q002744
—
TN
Enumeration date
08/24/2006
Last updated
11/10/2016
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