Brock, Jack A

Brock, Jack A is an individual health care provider with primary practice located at 4411 The 25 Way Ne Ste 150, Albuquerque NM 87109-5888. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Brock, Jack A can be contacted via phone (505) 332-6900.

Contact Information

Primary practice address
4411 The 25 Way Ne Ste 150 Albuquerque NM 87109-5888
Fax: (505) 332-6921
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 77-139 New Mexico

Profile Details

NPI number 1851395610
LBN Legal business name Brock, Jack A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 9th, 2005
Last updated Oct 18th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851395610 NPPES
New Mexico MEDICAID L0634
New Mexico MEDICAID 52713
New Mexico MEDICAID 22467
New Mexico MEDICAID 45138
New Mexico Other 2258272

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