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
Phone: (812) 375-3330
Fax: (812) 375-3329
Website:
Health care specialties
Specialty | Code | License # | 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1073551248 | NPPES |
Indiana | Other | 10000575A | INDIANA LICENSE |
Indiana | Other | 000000991456 | INDIANA LICENSE |
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