Provider Demographics
NPI:1043286594
Name:BROCK, JOSEPH L (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:BROCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:ATT: CVMC FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-225-5810
Mailing Address - Fax:802-371-4821
Practice Address - Street 1:246 GRANGER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-5344
Practice Address - Country:US
Practice Address - Phone:802-225-5810
Practice Address - Fax:802-371-4821
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2014-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301047460207Q00000X
VT042.0011623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5621038OtherAETNA
MI101317OtherPREFERRED CHOICES
MA34918OtherHEALTH PLAN OF MI
MI6589077OtherCIGNA
MA0806100351OtherBLUE CROSS BLUE SHIELD
VT1015396Medicaid
MI0806100351OtherBLUE CARE NETWORK
MI300207909004OtherTRICARE
MI4556208Medicaid
MI4556208OtherMOLINA HEALTHCARE
MIA74772OtherPRIORITY HEALTH
MIP00091158OtherRAILROAD MEDICARE
VT1015396Medicaid
MA34918OtherHEALTH PLAN OF MI
MI0N79660002Medicare ID - Type Unspecified