Provider Demographics
NPI:1154327260
Name:SHROCK, KEVIN B (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:B
Last Name:SHROCK
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 1:1414 SE 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1910
Mailing Address - Country:US
Mailing Address - Phone:954-764-8033
Mailing Address - Fax:954-764-5522
Practice Address - Street 1:1414 SE 3RD AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1910
Practice Address - Country:US
Practice Address - Phone:954-764-8033
Practice Address - Fax:954-764-5522
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066180207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery