Organization
ROBERT J BROCK MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT J BROCK M.D. (PRESIDENT)
(208) 525-3220
Entity
Organization
Contact information
Practice address
2420 EAST 25TH CIRCLE, SUITE B, IDAHO FALLS, ID 83404-7549
(208) 525-3220
(208) 525-3227
Mailing address
PO BOX 3070, IDAHO FALLS, ID 83403-3070
(208) 525-3220
(208) 525-3227
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
M7908
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8055716000
—
ID
Enumeration date
02/07/2007
Last updated
12/03/2007
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