Provider Demographics
NPI:1518907732
Name:BROCK, STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:BROCK
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 1:811 W I-20
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5870
Mailing Address - Country:US
Mailing Address - Phone:817-468-3393
Mailing Address - Fax:817-468-8734
Practice Address - Street 1:811 INTERSTATE 20 W
Practice Address - Street 2:SUITE 120
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5870
Practice Address - Country:US
Practice Address - Phone:817-468-3393
Practice Address - Fax:817-468-8734
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128089306Medicaid
TX352082YL7AOtherMEDICARE - OTHER COUNTY
TX128089307OtherMEDICAID OTHER
TX128089307OtherMEDICAID OTHER
TX80X107Medicare ID - Type Unspecified
TX128089305Medicare ID - Type Unspecified