Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | POD-000816 | AZ |
NPI | 1093238016 |
---|---|
Provider Name | Dr. Kara Brock |
First Address | Safford, AZ 85546-4081 |
Second Address | Safford, AZ 85546-4081 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2017 |
Last Update Date | 02/08/2021 |