Individual
JEFFREY MICHAEL BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
812 STATE RD, CHERAW, SC 29520-7113
(843) 537-0961
(843) 537-0908
Mailing address
PO BOX 1090, HARTSVILLE, SC 29551-1090
(843) 857-0111
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
31021
SC
207Q00000X
Family Medicine Physician
4301097004
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
310210
—
SC
Enumeration date
06/18/2008
Last updated
03/20/2024
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