Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | P0011 | TX |
NPI | 1124121108 |
---|---|
Provider Name | Jana Johnson Brock |
First Address | Allen, TX 75013 |
Second Address | Allen, TX 75013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 14/09/2020 |