Individual
CHARLES BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13330 USF LAUREL DR, TAMPA, FL 33612-6601
(813) 974-2201
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
ME69227
FL
208VP0000X
Pain Medicine Physician
Primary
ME069227
FL
208VP0014X
Interventional Pain Medicine Physician
ME069227
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
254486500
—
FL
01
—
43672
BLUE CROSS BLUE SHIELD
FL
Enumeration date
07/26/2006
Last updated
04/05/2021
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