Jackson, Brock

Jackson, Brock is an individual health care provider with primary practice located at 1661 E Camelback Rd Suite 160, Phoenix AZ 85016-3911. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Jackson, Brock can be contacted via phone (602) 241-1671.

Contact Information

Primary practice address
1661 E Camelback Rd Suite 160 Phoenix AZ 85016-3911
Phone: (602) 241-1671
Fax: (602) 274-6181
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 32949 Arizona

Profile Details

NPI number 1821093667
LBN Legal business name Jackson, Brock
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 17th, 2005
Last updated Mar 19th, 2015 - about 9 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 1821093667 NPPES
Arizona MEDICAID 939902

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