Individual
MR. CASEY SIMON BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
920 E 1ST ST STE 201, DULUTH, MN 55805-2215
(612) 444-3247
(612) 888-4247
Mailing address
2480 WHITE BEAR AVE N STE 104, MAPLEWOOD, MN 55109-4568
(612) 444-3247
(612) 888-9247
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
13273
MN
363A00000X
Physician Assistant
5908-23
WI
363A00000X
Physician Assistant
PA09822
TX
363A00000X
Physician Assistant
PA9114121
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18819533602
—
MN
Enumeration date
05/14/2012
Last updated
10/19/2023
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