Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 35927 | CO |
N | 207PE0004X | Emergency Medical Services | 4301029318 | MI |
NPI | 1174583900 |
---|---|
Provider Name | Dr. Brooks F Bock |
First Address | Avon, CO 81620-4330 |
Second Address | Avon, CO 81620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 20/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101709949 | (05) | MI |
101987786 | (05) | MI |
80885039 | (05) | CO |
B48256 | (02) | MI |
BB029318 | BC/BS OF MI (01) | MI |