Provider Demographics
NPI:1215977814
Name:BROCK, DONALD THOMAS (DO)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:THOMAS
Last Name:BROCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 SE 11TH ST
Mailing Address - Street 2:
Mailing Address - City:ANADARKO
Mailing Address - State:OK
Mailing Address - Zip Code:73005
Mailing Address - Country:US
Mailing Address - Phone:405-247-9500
Mailing Address - Fax:405-247-9505
Practice Address - Street 1:412 SE 11TH ST
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005-4442
Practice Address - Country:US
Practice Address - Phone:405-247-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG93510Medicare UPIN