Provider Demographics
NPI:1467731695
Name:BROCK, PAUL TALMAGE II (CRNA)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:TALMAGE
Last Name:BROCK
Suffix:II
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:PO BOX 751274
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1274
Mailing Address - Country:US
Mailing Address - Phone:919-620-4917
Mailing Address - Fax:919-620-4921
Practice Address - Street 1:2100 ERWIN ROAD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3941
Practice Address - Country:US
Practice Address - Phone:919-620-4917
Practice Address - Fax:919-620-4921
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
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Provider Licenses
StateLicense IDTaxonomies
NC209106367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered