Provider Demographics
NPI:1033145123
Name:IRVIN P. BROCK III, M.D., P.A.
Entity Type:Organization
Organization Name:IRVIN P. BROCK III, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRVIN
Authorized Official - Middle Name:PETE
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:830-438-4788
Mailing Address - Street 1:320 FOSSIL HILLS LOOP
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-6012
Mailing Address - Country:US
Mailing Address - Phone:830-885-2193
Mailing Address - Fax:
Practice Address - Street 1:160 CREEKSIDE PARK
Practice Address - Street 2:SUITE 202
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163
Practice Address - Country:US
Practice Address - Phone:830-438-4788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1535261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00512ZMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER