Provider Demographics
NPI:1093716748
Name:BROCK, E. JANE (DO)
Entity Type:Individual
Prefix:
First Name:E.
Middle Name:JANE
Last Name:BROCK
Suffix:
Gender:F
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:VUMC DEPARTMENT OF ANESTHESIOLOGY
Mailing Address - Street 2:2301 VUH
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-0001
Mailing Address - Country:US
Mailing Address - Phone:615-343-9979
Mailing Address - Fax:
Practice Address - Street 1:VUMC DEPARTMENT OF ANESTHESIOLOGY
Practice Address - Street 2:2301 VUH
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0001
Practice Address - Country:US
Practice Address - Phone:615-343-9979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02555207L00000X
TNDO00867207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64916661Medicaid
KYF62666Medicare UPIN
KY1267939Medicare ID - Type Unspecified