Individual
DALE WAYNE BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APN
Contact information
Practice address
2718A N MAIN ST, LIBERTY, TX 77575-3909
(936) 336-3616
Mailing address
2718A N MAIN ST, LIBERTY, TX 77575-3909
(936) 336-3616
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
603165
TX
363LF0000X
Family Nurse Practitioner
603165
TX
Other
Enumeration date
05/30/2006
Last updated
07/15/2008
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