Individual
DANIEL PERRY BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2601 LAKE DR STE 201, RALEIGH, NC 27607-6689
(919) 341-3623
(919) 782-1669
Mailing address
406 ASHLAND DR, GOLDSBORO, NC 27530-9165
(252) 341-8278
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
181529
NC
367500000X
Certified Registered Nurse Anesthetist
079666
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
2099
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720252430
TRICARE
NC
05
—
8053243
—
NC
01
—
P00631832
RAILROAD MEDICARE
NC
Enumeration date
04/15/2008
Last updated
09/07/2023
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