Provider Demographics
NPI:1215970140
Name:BROCK, HOWARD ROBERT (MD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:ROBERT
Last Name:BROCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3350
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38557-3350
Mailing Address - Country:US
Mailing Address - Phone:931-248-1414
Mailing Address - Fax:931-707-5178
Practice Address - Street 1:331 HINCH ST
Practice Address - Street 2:
Practice Address - City:SPRING CITY
Practice Address - State:TN
Practice Address - Zip Code:37381-5217
Practice Address - Country:US
Practice Address - Phone:931-248-1414
Practice Address - Fax:931-707-5178
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000036269207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3357233OtherCIGNA
TNTN0101OtherJOHN DEERE
TNP00190427OtherRAIROAD MEDICARE
TN702025457OtherCARITEN HEALTHCARE
TN4095858OtherBLUE CROSS BLUE SHIELD
TN4095858OtherBLUE CROSS BLUE SHIELD
3879527Medicare PIN
TN3357233OtherCIGNA
TN702025457OtherCARITEN HEALTHCARE