Provider Demographics
NPI:1497991830
Name:LEE R BROCK MD
Entity Type:Organization
Organization Name:LEE R BROCK MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-891-4444
Mailing Address - Street 1:4304 LAFAYETTE BLVD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-4234
Mailing Address - Country:US
Mailing Address - Phone:540-891-4444
Mailing Address - Fax:540-891-9034
Practice Address - Street 1:4304 LAFAYETTE BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4234
Practice Address - Country:US
Practice Address - Phone:540-891-4444
Practice Address - Fax:540-891-9034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty