Provider Demographics
NPI:1124288295
Name:BROCK, RACHEL M (MD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:M
Last Name:BROCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1099 FLORIDA AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2138
Mailing Address - Country:US
Mailing Address - Phone:321-632-6900
Mailing Address - Fax:321-639-7222
Practice Address - Street 1:1099 FLORIDA AVE S
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2138
Practice Address - Country:US
Practice Address - Phone:321-632-6900
Practice Address - Fax:321-639-7222
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME121769207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHZ843ZMedicare PIN
OK311956YRVAMedicare PIN