Brock, Jared L

Brock, Jared L is an individual health care provider with primary practice located at 4001 W Goeller Blvd Ste A , Columbus IN 47201-8309. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Brock, Jared L can be contacted via phone (812) 375-3330.

Contact Information

Primary practice address
4001 W Goeller Blvd Ste A Columbus IN 47201-8309
Fax: (812) 375-3329
Website:

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 10000575A Indiana

Profile Details

NPI number 1073551248
LBN Legal business name Brock, Jared L
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 2nd, 2006
Last updated Dec 5th, 2022 - about 3 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 1073551248 NPPES
Indiana Other 10000575A INDIANA LICENSE
Indiana Other 000000991456 INDIANA LICENSE

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