Individual
DR. GERALD JAY BROOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
123 NW 12TH AVE, APT. 1426, PORTLAND, OR 97209-4143
(757) 561-6056
Mailing address
123 NW 12TH AVE, APT. 1426, PORTLAND, OR 97209-4143
(757) 561-6056
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD27913
OR
Other
Enumeration date
12/07/2011
Last updated
12/07/2011
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